Words You Should Know
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American Health Benefit Exchanges
A new state-based marketplace where individuals without insurance and small businesses can compare and shop for affordable health plans. The plans must cover a set of essential health benefits and meet certain cost standards. Exchanges will be up and running in 2014.
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Accountable Care Organizations (ACOs)
A group of health care professionals and hospitals in a community that work together to coordinate care and help improve the quality of care for the patient. The group receives payment for all care and is held responsible for the quality and cost of care.
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Annual Wellness Exam (through Medicare)
A preventive visit to a health care professional that is now covered through Medicare Part B. The visit, which is offered once every 12 months, allows patients to work with their health care professional to develop or update a personalized prevention plan based on a patient’s health and risk factors.
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Biologic Medications
Medicines that are created through a biological process and are often used to treat chronic illnesses, such as diabetes or cancer. Biological medicines are sometimes used to treat conditions for which no other medical treatments are available.
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Children’s Health Insurance Program
The Children’s Health Insurance Program (CHIP) is a health insurance program for children whose families earn too much to qualify for Medicaid but not enough to afford private insurance. In some states, pregnant women are covered through CHIP. Each state has its own CHIP program and receives partial funding from the federal government.
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Community First Choice Option
A new health care option for people in Medicaid who have disabilities. The program provides community-based health care services and support, including those that help people accomplish activities of everyday life and health-related tasks. It is an alternative to services offered at a hospital, nursing facility, or intermediate care facility.
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Consumer Operated and Oriented Plan Program
The program will help create health insurance plans, or CO-Ops, that are offered by qualified nonprofit insurers in the individual and small group markets.
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Dependent
A family member, such as a spouse, partner or child, who receives coverage through the policyholder’s health plan.
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Disability
A health impairment that limits major life activities. Activities may include seeing, hearing, walking and tasks that limit a person’s ability to work. Health insurance plans have different disability standards.
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Dollar Limits
A limit that health insurance companies may put on the amount of care they cover. Once individuals reach that dollar limit, they are required to pay for additional health costs on their own. Insurance companies can no longer put dollar limits on the amount of care they will cover in your lifetime. Annual dollar limits are being phased out between now and 2014.
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Doughnut Hole
A gap in drug coverage for individuals enrolled in the Medicare Part D prescription plan. You reach the gap once your total spending on prescriptions reaches an initial coverage limit, after which you pay for remaining drug costs. Once a certain amount is reached out-of-pocket, the plan will help pay for drugs again.
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Exchanges
A new state-based marketplace where individuals without insurance and small businesses can compare and shop for affordable health plans. The plans must cover a set of essential health benefits and meet certain cost standards. Exchanges will be up and running in 2014.
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Electronic Health Records
A computerized version of a patient’s health records and health information that can be easily shared by doctors and health care organizations.
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Employer-sponsored Insurance
A health insurance plan that individuals get through their job.
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Essential Health Care Services/Benefits
A set of basic health care services that health insurance plans will be required to cover beginning in 2014. Such services include hospitalizations and other emergency services, maternity and newborn care, mental health, preventative care, children’s services and more.
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Extra Help
A program that helps some people in Medicare with limited resources and income pay for prescription drugs.
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Flexible Spending Accounts
An account that employees can set up through their employer to pay for out-of-pocket health expenses using pre-tax dollars. Individuals decide the amount of money that is taken out of their paycheck to pay for the expenses.
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Grandfathered Health Plans
Group and individual health insurance plans that were in place or purchased on or before March 23, 2010. Grandfathered plans are exempt from parts of the health care law. Plans may lose the exemption if they make certain changes to their policies.
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Health Disparities
Refers to differences in quality of health and health care among different groups of people. The differences can affect how often a person gets sick and how they get sick. Groups that are most often affected include women, children, elderly individuals, racial and ethnic minorities, people with disabilities and people living in rural areas.
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Health Reimbursement Accounts
Employer-operated plans that reimburse employees for qualified medical expenses.
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Independence at Home program
A program for people in Medicare who suffer from multiple chronic illnesses that brings primary health services into the home. Care is directed by teams of health care professionals and is designed to best treat a person’s chronic conditions.
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Individual Health Insurance Plans
Health insurance plans bought by individuals who do not have employer-sponsored coverage. Plans are regulated under state law.
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Medicaid
A health insurance program that provides coverage to certain low-income Americans. States design and run the program. The federal government sets Medicaid guidelines and also helps fund the program.
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Medicaid Health Home
A setting where people in Medicaid with chronic conditions receive comprehensive and coordinated health care services from a primary care professional. Medicaid health homes are meant to help build an ongoing relationship between the patient and health care professional to help reduce hospital and nursing home admissions as a result of a person’s chronic conditions.
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Medicare
A federal health insurance program that covers individuals ages 65 and older and some younger people with disabilities. Medicare also covers individuals with end-stage renal disease, and Lou Gehrig’s disease.
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Medicare Advantage
A program that allows individuals to receive their Medicare health benefits through private insurance plans.
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Medicare Part B
A Medicare program that helps pay for doctor visits, outpatient care and other services. It also covers preventive services.
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Medicare Part D
A Medicare program that helps pay for prescription drugs for people enrolled in a Medicare Prescription Drug Plan or a Medicare Advantage Plan that offers prescription coverage.
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National Health Service Corps
A scholarship and loan repayment program that helps place health care professionals in rural and urban communities.
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Pre-Existing Condition Insurance Plan
A health insurance plan that provides coverage for individuals who have a pre-existing condition, who have been denied coverage and who have been uninsured for at least six months. The program will provide coverage until 2014, when health insurance plans will not be able to deny coverage because of pre-existing conditions.
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Pre-Existing Condition
An illness or disability that an individual had before enrolling in a health coverage plan. Each state law defines pre-existing conditions differently. Examples of pre-existing conditions are asthma, diabetes and cancer.
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Preventive Services
Health services that help detect and prevent illness. Services may include check-ups, counseling and screenings.
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Tax Credits
For individuals, a tax credit is an amount that can be subtracted from the amount of income tax a person owes. For business owners, a tax credit is an amount that can be subtracted from the amount of business tax a business owes. Tax credits will be offered to some individuals and small businesses that shop for health insurance on state-based marketplaces called exchanges to help cover the cost of insurance.
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Teaching Health Centers
Community-based health care centers that operate primary care residency programs.