Dynamics of Healthcare Unit 3

Accountable Care Organization (ACO)

A group of doctors and hospitals that work together to give coordinated, high-quality care and reduce costs.

American Medical Association (AMA)

A national organization that represents doctors and helps set medical standards.

Bundled payment

A single payment for all services needed for a treatment or condition.

Capitation

A fixed amount paid per patient, no matter how many services they use.

Children’s Health Insurance Plan (CHIP)

Low-cost health insurance for children in families who need help but don’t qualify for Medicaid.

Copay

A set dollar amount you pay for a service.

Coinsurance

The percent you pay for a service after your deductible is met.

Deductible

The amount you must pay before your insurance starts covering care.

Department of Health and Human Services (HHS)

The U.S. agency that oversees national health programs.

Diagnosis-related groups (DRG)

A system Medicare uses to pay hospitals based on diagnosis.

Dual-eligible

A person who qualifies for both Medicare and Medicaid.

Exclusive provider organization (EPO)

A plan that only covers care from in-network providers.

Fee-for-service

Payment system where providers are paid for each service.

Health insurance marketplace

The online place to compare and buy health insurance.

Health maintenance organization (HMO)

A plan that requires using in-network doctors and usually referrals.

High-deductible health plan with a savings option (HDHP/SO)

A high-deductible plan paired with a tax-free health savings account.

Long-term services and supports (LTSS)

Long-term help with daily living tasks due to age or disability.

Managed care organization (MCOs)

Groups that manage health services while controlling costs.

Marketplace subsidies

Government financial help that lowers insurance costs on the marketplace.

Medicaid

Public insurance for people with low income.

Medicare

Federal insurance mainly for people 65+ or those with certain disabilities.

Network

The providers and facilities your insurance plan covers.

Preferred provider organization (PPOs)

A plan that allows out-of-network care but cheaper in-network.

Private Health insurance

Insurance from private companies, not the government.

Premium

The monthly amount you pay to keep your insurance.