Outpatient Care

Medical services or treatments that do not require an overnight hospital stay. Medicare Part B, Medicaid, and CHIP cover outpatient care, which includes doctor visits, diagnostic tests, and certain surgeries.

Preventive Services

Healthcare services aimed at preventing illness or detecting health issues early. Medicare, Medicaid, CHIP, and ACA plans cover preventive services, such as vaccinations, screenings, and annual wellness visits, often at no additional cost.

Primary Care Physician (PCP)

A healthcare provider who acts as the first point of contact for an individual’s healthcare needs and coordinates further specialist care if necessary. Many Medicare Advantage, Medicaid, and ACA plans require enrollees to choose a PCP.

Rehabilitation Services

Medical services aimed at helping individuals recover and regain skills after illness, injury, or surgery. These services, which include physical, occupational, and speech therapy, are covered by Medicare, Medicaid, and CHIP.

Respite Care

Short-term care provided to individuals with chronic illnesses or disabilities to give their regular caregivers temporary relief. Medicaid and some Medicare plans may cover respite care as part of long-term care or hospice services.

Skilled Nursing Facility (SNF)

A healthcare facility that provides high-level medical care and rehabilitation services after hospitalization. Medicare Part A covers skilled nursing care for a limited period after a qualifying hospital stay, while Medicaid may cover long-term stays for eligible individuals.

Special Enrollment Period (SEP)

A time outside the Open Enrollment Period when individuals can sign up for or change their health insurance plan due to qualifying life events such as marriage, birth of a child, or loss of other coverage. SEPs apply to both ACA Marketplace and Medicare plans.

Telehealth

The use of technology, such as video calls or phone consultations, to provide healthcare services remotely. Telehealth is increasingly covered by Medicare, Medicaid, CHIP, and ACA plans, especially for mental health services and routine checkups.

Urgent Care

Medical services provided for conditions that require prompt attention but are not serious enough for emergency room care. Medicare, Medicaid, CHIP, and ACA Marketplace plans often cover urgent care visits, with varying copayments or coinsurance.

Uncompensated Care

Medical services provided to patients who are unable to pay and do not have insurance coverage. Medicaid expansion under the ACA has helped reduce the amount of uncompensated care provided by hospitals by covering more low-income individuals.

Urgent Need Care (Medicare)

Immediate medical care required for sudden illnesses or injuries that are not life-threatening but require prompt attention. Medicare Advantage plans typically cover urgent care services, and they may have lower out-of-pocket costs than emergency room visits.

Vaccinations

Immunizations provided to protect against diseases such as the flu, measles, and pneumonia. Medicare, Medicaid, CHIP, and ACA plans cover many vaccinations, often without out-of-pocket costs, especially as part of preventive services.

Wellness Visit

A preventive health check-up aimed at assessing overall health, identifying potential health risks, and offering screenings and counseling. Medicare covers an annual wellness visit, while Medicaid, CHIP, and ACA plans cover various preventive services, including wellness visits.

X-Ray Services

Diagnostic imaging services used to visualize internal structures of the body. Medicare Part B, Medicaid, and CHIP cover X-rays when deemed medically necessary, while ACA Marketplace plans also cover diagnostic services, including X-rays, as part of essential health benefits.

Zoster (Shingles) Vaccine

A vaccination to protect against shingles, a painful rash caused by the reactivation of the chickenpox virus. Medicare Part D and some Medicaid programs cover the shingles vaccine, while ACA Marketplace plans include vaccinations as part of preventive services.