Glossary
Tags
- ACA
- ACA Marketplace
- ACA subsidies
- CHIP
- CMS
- ESRD
- Extra Help
- FMAP
- FPL
- FQHC
- FSA
- HCBS
- HMO
- HRA
- HSA
- IEP
- IRMAA
- Joint Commision
- KFF
- LCD
- LIS
- Marketplace
- Medicaid
- Medicaid (rare)
- Medicaid expansion
- Medicare
- Medicare Advantage
- Medicare Part A
- Medicare Part B
- Medicare Part D
- Medicare coordination
- Medigap
- NCD
- NEMT
- NOMNC
- Original Medicare
- PCP
- Part A
- Part B
- Part C
- Part D
- QLE
- QMB
- SEP
- SNF
- SNP
- SSI
- Section 1115
- Silver Plan
- Silver plan
Durable Medical Equipment (DME)
Equipment prescribed by a healthcare provider that can be used at home to help with medical conditions, such as wheelchairs, crutches, oxygen tanks, and hospital beds. Medicare, Medicaid, and CHIP cover DME when deemed medically necessary.
Equipment prescribed by a healthcare provider that can be used at home to help with medical conditions, such as wheelchairs, crutches, oxygen tanks, and hospital beds. Medicare, Medicaid, and CHIP cover DME when deemed medically necessary.
Dependent Care
Care provided for children or dependent adults who require assistance with daily living. Medicaid may cover home or community-based services for dependent care under certain circumstances.
Care provided for children or dependent adults who require assistance with daily living. Medicaid may cover home or community-based services for dependent care under certain circumstances.
Essential Health Benefits (EHBs)
A set of 10 categories of healthcare services that all ACA-compliant health plans must cover. These services include emergency care, hospitalization, maternity and newborn care, prescription drugs, mental health services, and more.
A set of 10 categories of healthcare services that all ACA-compliant health plans must cover. These services include emergency care, hospitalization, maternity and newborn care, prescription drugs, mental health services, and more.
Fee-for-Service (FFS)
A traditional healthcare payment model in which healthcare providers are paid separately for each service provided to a patient, such as doctor visits, tests, or procedures. Medicare and Medicaid offer FFS options, although many states are moving towards managed care models.
A traditional healthcare payment model in which healthcare providers are paid separately for each service provided to a patient, such as doctor visits, tests, or procedures. Medicare and Medicaid offer FFS options, although many states are moving towards managed care models.
Inpatient Care
Medical treatment provided to a patient who is admitted to a hospital or facility for at least one overnight stay. Medicare Part A, Medicaid, and CHIP cover inpatient care, which includes hospital stays, surgery, and rehabilitation services.
Medical treatment provided to a patient who is admitted to a hospital or facility for at least one overnight stay. Medicare Part A, Medicaid, and CHIP cover inpatient care, which includes hospital stays, surgery, and rehabilitation services.
Integrated Care
A coordinated approach to healthcare that involves integrating physical, behavioral, and mental health services to provide holistic care. Integrated care models are often used in Medicare, Medicaid, and CHIP programs to improve outcomes.
A coordinated approach to healthcare that involves integrating physical, behavioral, and mental health services to provide holistic care. Integrated care models are often used in Medicare, Medicaid, and CHIP programs to improve outcomes.
Kidney Transplant
A surgical procedure to replace a failing kidney with a healthy one from a donor. Individuals with End-Stage Renal Disease (ESRD) are eligible for Medicare, regardless of age, and Medicare covers kidney transplants, dialysis, and related services.
A surgical procedure to replace a failing kidney with a healthy one from a donor. Individuals with End-Stage Renal Disease (ESRD) are eligible for Medicare, regardless of age, and Medicare covers kidney transplants, dialysis, and related services.
Level of Care (LOC)
A term used in Medicaid to determine the intensity of care required by an individual. LOC assessments are used to establish eligibility for long-term care services, such as nursing home care or home and community-based services.
A term used in Medicaid to determine the intensity of care required by an individual. LOC assessments are used to establish eligibility for long-term care services, such as nursing home care or home and community-based services.
Non-Emergency Medical Transportation (NEMT)
Transportation services provided to individuals who need assistance getting to and from medical appointments but do not require emergency care. Medicaid often covers NEMT for eligible beneficiaries, especially those with disabilities or mobility issues.
Transportation services provided to individuals who need assistance getting to and from medical appointments but do not require emergency care. Medicaid often covers NEMT for eligible beneficiaries, especially those with disabilities or mobility issues.
Nursing Home Care
Long-term care services provided in a nursing facility for individuals who need assistance with daily activities or medical care. Medicaid is the largest payer of nursing home care, though Medicare provides limited coverage for skilled nursing facility care.
Long-term care services provided in a nursing facility for individuals who need assistance with daily activities or medical care. Medicaid is the largest payer of nursing home care, though Medicare provides limited coverage for skilled nursing facility care.
Notice of Medicare Non-Coverage (NOMNC)
A formal notice that Medicare beneficiaries receive when their care is set to end, explaining that Medicare will no longer cover certain services. Beneficiaries have the right to appeal the decision if they disagree with the termination of coverage.
A formal notice that Medicare beneficiaries receive when their care is set to end, explaining that Medicare will no longer cover certain services. Beneficiaries have the right to appeal the decision if they disagree with the termination of coverage.
Prior Authorization
A requirement that certain healthcare services or medications must be approved by the health insurance provider before they are provided. Medicare, Medicaid, and ACA plans may require prior authorization for procedures or high-cost drugs.
A requirement that certain healthcare services or medications must be approved by the health insurance provider before they are provided. Medicare, Medicaid, and ACA plans may require prior authorization for procedures or high-cost drugs.