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
Group Health Plan
Health insurance coverage provided to a group of people, typically through an employer or union. Medicare coordinates benefits with group health plans when an individual is eligible for both.
Health insurance coverage provided to a group of people, typically through an employer or union. Medicare coordinates benefits with group health plans when an individual is eligible for both.
Global Payment
A type of payment arrangement in which a provider is paid a fixed amount for all care provided to a patient over a specified period, regardless of the actual number of services rendered. Global payment models are sometimes used in Medicare and Medicaid to improve cost control.
A type of payment arrangement in which a provider is paid a fixed amount for all care provided to a patient over a specified period, regardless of the actual number of services rendered. Global payment models are sometimes used in Medicare and Medicaid to improve cost control.
Gross Income
The total income earned before any deductions, such as taxes or retirement contributions, are taken out. Gross income is used to determine eligibility for programs like Medicaid, CHIP, and ACA Marketplace subsidies.
The total income earned before any deductions, such as taxes or retirement contributions, are taken out. Gross income is used to determine eligibility for programs like Medicaid, CHIP, and ACA Marketplace subsidies.
Guaranteed Renewal
A feature of health insurance plans that requires the insurer to renew the policyholder’s coverage at the end of each term, regardless of changes in health status. This is required for ACA-compliant plans and Medicare Supplement (Medigap) plans.
A feature of health insurance plans that requires the insurer to renew the policyholder’s coverage at the end of each term, regardless of changes in health status. This is required for ACA-compliant plans and Medicare Supplement (Medigap) plans.
Geriatric Care
Specialized healthcare services for older adults, focusing on age-related conditions such as mobility issues, chronic diseases, and dementia. Medicare and Medicaid provide coverage for many geriatric care services, including nursing home care and home healthcare.
Specialized healthcare services for older adults, focusing on age-related conditions such as mobility issues, chronic diseases, and dementia. Medicare and Medicaid provide coverage for many geriatric care services, including nursing home care and home healthcare.
Health Insurance Marketplace
An online platform established by the ACA where individuals and small businesses can compare and purchase health insurance plans. It also provides information on eligibility for subsidies and cost-sharing reductions.
An online platform established by the ACA where individuals and small businesses can compare and purchase health insurance plans. It also provides information on eligibility for subsidies and cost-sharing reductions.
Health Savings Account (HSA)
A tax-advantaged account used to save and pay for qualified medical expenses. HSAs are available to individuals enrolled in high-deductible health plans (HDHPs) and offer tax-free contributions, growth, and withdrawals for healthcare costs.
A tax-advantaged account used to save and pay for qualified medical expenses. HSAs are available to individuals enrolled in high-deductible health plans (HDHPs) and offer tax-free contributions, growth, and withdrawals for healthcare costs.
Home Health Care
Medical and personal care services provided to individuals in their own homes, often after hospitalization or surgery. Medicare, Medicaid, and CHIP cover home health care services, including nursing care, physical therapy, and assistance with daily activities.
Medical and personal care services provided to individuals in their own homes, often after hospitalization or surgery. Medicare, Medicaid, and CHIP cover home health care services, including nursing care, physical therapy, and assistance with daily activities.
Hospice Care
End-of-life care provided to individuals with terminal illnesses, focusing on comfort and quality of life rather than curative treatment. Medicare and Medicaid cover hospice care, including medical services, emotional support, and pain management.
End-of-life care provided to individuals with terminal illnesses, focusing on comfort and quality of life rather than curative treatment. Medicare and Medicaid cover hospice care, including medical services, emotional support, and pain management.
High-Deductible Health Plan (HDHP)
A health insurance plan with a higher deductible and lower premiums. HDHPs are often paired with a Health Savings Account (HSA) to help cover out-of-pocket expenses. These plans are available through the ACA Marketplace and employer-sponsored coverage.
A health insurance plan with a higher deductible and lower premiums. HDHPs are often paired with a Health Savings Account (HSA) to help cover out-of-pocket expenses. These plans are available through the ACA Marketplace and employer-sponsored coverage.
Health Reimbursement Arrangement (HRA)
An employer-funded arrangement that reimburses employees for qualified medical expenses. Unlike an HSA, only the employer can contribute to an HRA, and the funds can be used for various healthcare costs, such as copayments and deductibles.
An employer-funded arrangement that reimburses employees for qualified medical expenses. Unlike an HSA, only the employer can contribute to an HRA, and the funds can be used for various healthcare costs, such as copayments and deductibles.
Home and Community-Based Services (HCBS)
Services that allow individuals, particularly those with disabilities or chronic illnesses, to receive care in their homes or communities rather than in institutional settings. Medicaid provides coverage for HCBS, including personal care, nursing, and therapy.
Services that allow individuals, particularly those with disabilities or chronic illnesses, to receive care in their homes or communities rather than in institutional settings. Medicaid provides coverage for HCBS, including personal care, nursing, and therapy.
Hospital Indemnity Insurance
A type of supplemental insurance that provides a cash benefit for each day an individual is hospitalized. This insurance can help cover out-of-pocket costs not paid by Medicare, Medicaid, or private health insurance.
A type of supplemental insurance that provides a cash benefit for each day an individual is hospitalized. This insurance can help cover out-of-pocket costs not paid by Medicare, Medicaid, or private health insurance.
Health Maintenance Organization (HMO)
A type of health insurance plan that provides coverage through a network of doctors, hospitals, and other healthcare providers. Enrollees must typically choose a primary care physician and get referrals to see specialists. ACA, Medicaid, and CHIP offer HMO options.
A type of health insurance plan that provides coverage through a network of doctors, hospitals, and other healthcare providers. Enrollees must typically choose a primary care physician and get referrals to see specialists. ACA, Medicaid, and CHIP offer HMO options.
Hospice Respite Care
Short-term inpatient care provided to hospice patients to give their primary caregivers temporary relief. Medicare and Medicaid cover respite care as part of hospice services for individuals receiving end-of-life care.
Short-term inpatient care provided to hospice patients to give their primary caregivers temporary relief. Medicare and Medicaid cover respite care as part of hospice services for individuals receiving end-of-life care.
Income Limits
The maximum income level a household can earn and still qualify for government programs like Medicaid, CHIP, and ACA subsidies. Income limits are typically based on a percentage of the Federal Poverty Level (FPL).
The maximum income level a household can earn and still qualify for government programs like Medicaid, CHIP, and ACA subsidies. Income limits are typically based on a percentage of the Federal Poverty Level (FPL).
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.
Initial Enrollment Period (IEP)
The seven-month window when an individual is first eligible to sign up for Medicare Part A and Part B. This period begins three months before the individual turns 65, includes their birthday month, and extends three months after.
The seven-month window when an individual is first eligible to sign up for Medicare Part A and Part B. This period begins three months before the individual turns 65, includes their birthday month, and extends three months after.
Individual Mandate
A provision of the ACA that required individuals to have health insurance or pay a penalty. While the federal penalty was eliminated in 2019, some states still enforce individual mandates.
A provision of the ACA that required individuals to have health insurance or pay a penalty. While the federal penalty was eliminated in 2019, some states still enforce individual mandates.
Insurance Premium
The amount paid, often monthly, for health insurance coverage. Premiums are required to maintain enrollment in programs like ACA Marketplace plans, Medicare, Medicaid, and private health insurance.
The amount paid, often monthly, for health insurance coverage. Premiums are required to maintain enrollment in programs like ACA Marketplace plans, Medicare, Medicaid, and private health insurance.