Health Science Theory

deductible (1)

the amount of money that an individual pays before the benefits of health insurance kick in and coinsurance starts (1)

out of pocket max (1)

after you have paid this amount of money, your health insurance will cover 100% of your costs for medical services that are included in your plan (1)

co-pay (1)

the flat fee that an individual is expected to pay for a medical service, such as a doctor’s appointment (1)

co-insurance (1)

the percentage of money that you are expected to pay after the deductible is reached (1)

premium (1)

the amount of money that you and/or your employer pays the insurance company pays the insurance company every month or year as part of the insurance plan

like a subscription (1)

premium (2)

the amount you pay every month for insurance (2)

deductible (2)

the amount you must pay before insurance begins helping (2)

copay (2)

a fixed fee you pay every time you get medical care (2)

coinsurance (2)

the percentage of costs you share with your insurance after the deductible (2)

out-of-pocket maximum (2)

the most you will pay in a year; after this, insurance pays 100% (2)

example: deductible

example: before her insurance helps, she pays the first $500 of her medical bills

example: copay

example: she pays $25 every time she visits her doctor

example: out of pocket maximum

example: after she pays $5000 in one year, her insurance covers everything else

example: coinsurance

example: james goes to the ER and pays 20% of the $2000 bill ($400) while insurance pays 80%

example: premium

example: maria pays $200 every month, even if she doesn’t go to the doctor

example: deductible

example: james must pay $1000 of his surgery bill before insurance starts helping

example: premium

example: lauren pays $150 every month for her health insurance plan

example: copay

example: each time sarah picks up a prescription, she pays $10 at the pharmacy

example: out of pocket maximum

example: after bella has spent $6500 on her health care this year, insurance pays everything else

example: coinsurance

example: malik’s plan requires him to pay 30% of the cost for his MRI, while insurance covers the other 70%

medicare (1)

• government funded insurance program

• people over the age of 65 are eligible

• also covers people of any age who have a disability

(1)

medicaid (1)

• insurance program for people with low incomes and few personal assets

• paid for by state and federal taxes

(1)

worker’s compensation (1)

• form of government insurance

• provides wage replacement and medical benefits for employees injured while at work

• most states require employers to have workers comp insurance

(1)

tricare (1)

• health care program of the united states department of defense military health system

• provides civilian health benefits for u.s. armed forces military personnel, military retirees, and their dependents, including some members of the reserve component

(1)

managed care (1)

a system designed to reduce healthcare costs while still providing needed services (1)

hmo (health maintenance organization) (1)

patients pay a fixed fee to get full medical care, but only from doctors and hospitals in the ___ network (1)

ppo ( preferred provider organization) (1)

patients can see any doctor, but costs are lower if they use doctors and hospitals within the ___ preferred network (1)

hmo (2)

• usually lower, fixed monthly fee

• must use doctors in the ___ network

• need a referral from primary care doctor to see a specialist

• less flexible, but cheaper

• people who want low cost and don’t mind limited choices

(2)

ppo (2)

• higher than (other) but still controlled

• can see any doctor but cheaper in-network

• no referral needed to see specialist

• more flexible but more expensive

• people who want more freedom to choose doctors

(2)

hmo (3)

a patient who wants the lowest monthly cost and doesn’t mind seeing only certain doctors (3)

ppo (3)

a patient who travels often and wants more doctor options (3)

cms (centers for medicare & medicaid services) (1)

• main role: run major health care programs like medicare, medicaid, and the children’s health insurance program (CHIP)

• other duties

  • set rules for hospitals, nursing homes, and clincs to ensure quality and safety

  • oversees the affordable care act insurance marketplaces

  • works to keep healthcare costs down and improve patient care