Healthcare Glossary

The healthcare system can be extremely confusing and difficult to navigate. We’re breaking down the healthcare language barrier one word at a time, from deductible to PPO, and everything in between.

Have a term you want explained? Contact us.

B

Balance Billing

Balance billing often occurs when a patient is receiving out-of-network care but doesn’t realize it. The patient then receives a “surprise” bill for services their insurance won’t cover.

Benefits

Benefits are the services or items covered under a health insurance plan.

C

Children’s Health Insurance Program (CHIP)

CHIP is a government program that provides health insurance to children from lower-income families.

COBRA

COBRA temporarily allows you to keep your employer-based insurance after your employment ends. You’re obligated to pay 100% of the premiums, including the portion the employer used to contribute.

Coinsurance

The percentage of costs of a covered health service you pay once you’ve met your deductible. For example, if you have healthcare services that cost $10,000 and your deductible is $3,000 and your coinsurance is 20%, you’ll pay 20% of the remaining $7,000, or $1,400.

Co-pay

A co-pay (or co-payment) is your share of the payment for a medical expense. For example, if a doctor charges $150 for a visit, insurance may pay $125 of the fee and the patient’s co-pay is $25

Cost-Sharing Reduction (CSR)

CSR payments are government subsidies paid to insurers to help keep premiums low for lower-income Americans.

D

Deductible

A deductible is an amount that you have to pay before your insurance starts paying for your healthcare. For example, if your deductible is $2,000, your insurance company starts paying only after you have paid for the first $2,000 worth of medical bills.

Dependent

A dependent is someone who relies on your health insurance, such as a spouse or child.

DSH

DSH payments (Disproportionate Share Hospital) are payments made by the federal government to hospitals that serve Medicaid and uninsured patients, to help cover uncompensated care costs that they incur in serving these vulnerable populations.

E

Essential Benefits

Under the Affordable Care Act, there are 10 “essential health benefits” (EHB) that insurers are required to provide, including emergency services, maternity care, mental health treatment, and others.

F

Family and Medical Leave Act (FMLA)

FMLA is a federal law that guarantees up to 12 weeks of job protected leave for certain employees when they have a serious illness, have to care for aa family member, or other certain circumstances.

FSA

A flexible spending account (FSA) allows you to set aside pre-tax income to help pay for certain medical expenses. Your employer has the opportunity to also contribute, but is not obligated to.

H

HMO

A health maintenance organization (HMO) is a type of health plan with which you choose a primary care physician, and all healthcare has to go through them (you can receive referrals to see specialists).

HRA

A health reimbursement arrangement (HRA) is an account that only your employer can contribute to, that helps you pay for qualified medical care that isn’t covered under your own healthcare plan.

HSA

A health savings account (HSA) is a personal savings account that you and your employer both contribute to that helps you save for out-of-pocket medical expenses.

I

Inpatient Service

Any medical service that’s administered during a hospital stay, where room and board are charged.

M

Medicaid

Medicaid is a government program for lower-income Americans that provides free or low-cost health insurance.

Medicare

Medicare is a government program for Americans 65 years or older that helps cover certain medical expenses.

N

Navigator

An individual or organization trained to help guide Americans through the process of selecting the appropriate healthcare plan.

Network

Everything covered by your health insurance, usually at zero or minimal cost. If you receive medical services that are “out-of-network”, your insurance may not cover the costs.

O

Open Enrollment

Open Enrollment is the period each year during which Americans can select health insurance. This period typically lasts several weeks towards the end of the year.

Outpatient Service

Any medical service that does not require an overnight stay at a hospital.

Out-pocket maximum

This is the maximum amount that you can pay in one year before your health insurance covers all other healthcare-related payments that year.

P

PPO

A preferred provider organization (PPO) offers more flexibility and does not require you to have a primary physician and does not require referrals for any doctor within your network.

Premium

Your premium is the fixed amount you pay for your health insurance every single month whether you use your insurance or not.

Q

Qualifying Life Event

Dramatic changes in your life that might occur that makes you eligible for a “special enrollment period” for insurance.

R

Reinsurance

An insurance policy health insurers purchase to protect them from high claims, thus protecting healthcare consumers.

W

Well-Woman Visit

Similar to an annual physical, a well-woman visit is a visit between a woman and her provider to discuss health habits, undergo routine exams, and set health goals.