Coinsurance: The percentage of costs of a covered
health care service you pay after you have paid your
deductible.
Copayment: A fixed amount you pay for a covered
health care service after you have paid your
deductible.
Cost Sharing: The share of costs covered by your
insurance that you pay out of your own pocket. This
term generally includes deductibles, coinsurance, and
copayments, or similar charges, but it does not include
premiums, balance billing amounts for non-network
providers, or the cost(s) of non-covered services. Cost
sharing in Medicaid and CHIP also includes premiums.
Fee for Service: A method in which doctors and
other health care providers are paid for each service
performed. Examples of services include tests and
office visits.
Health Insurance: A contract that requires your health
insurer to pay some or all of your health care costs in
exchange for a premium.
Inpatient Care: Health care that you get when you’re
admitted as an inpatient to a health care facility, like a
hospital or skilled nursing facility.
Medicaid: Insurance program that provides free or
low-cost health coverage to some low-income people,
families and children, pregnant women, the elderly, and
people with disabilities. You can apply anytime. If you
qualify, your coverage can begin immediately.
Medically Necessary: Health care services or supplies
needed to diagnose or treat an illness, injury, condition,
disease or its symptoms and that meet accepted
standards of medicine.
Medicare: A federal health insurance program for
people 65 and older and certain younger people with
disabilities. It also covers people with End-Stage Renal
Disease (permanent kidney failure requiring dialysis or a
transplant, sometimes called ESRD).
Network: The facilities, providers, and suppliers
your health insurer or plan has contracted with to
provide services.
Primary Care: Health services that cover a range
of prevention, wellness, and treatment for common
illnesses. Primary care providers include doctors, nurses,
nurse practitioners, and physician assistants. They often
maintain long-term relationships with you and advise and
treat you on a range of health related issues. They may
also coordinate your care with specialists.
Plan: A benefit your employer, union or other group
sponsor provides to you to pay for your health care
services.
Premium: The amount you pay for your health insurance
every month. In addition to your premium, you usually
have to pay other costs for your health care, including a
deductible, copayments, and coinsurance.
Uncompensated Care: Health care or services
provided by hospitals or health care providers that
are not reimbursed.