Chapter 27: Health Insurance Basics
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15 Terms
What is a premium?
Amount paid for insurance coverage.
What is a deductible?
Amount the patient pays before insurance begins paying covered services.
What is a copayment?
Fixed amount paid for a service.
What is coinsurance?
Percentage of cost the patient pays after deductible.
What is Medicare Part A?
Hospital/inpatient insurance.
What is Medicare Part B?
Medical/outpatient insurance.
What is Medicare Part C?
Medicare Advantage through Medicare-approved private plans.
What is Medicare Part D?
Prescription drug coverage.
What is Medicaid?
State/federal insurance program for eligible low-income or qualifying individuals.
What is TRICARE?
Health program for eligible military members, retirees, and families.
What is workers' compensation?
Insurance for work-related injuries/illnesses.
What is an HMO?
Plan often requiring network providers and PCP referrals.
What is a PPO?
Plan with more provider flexibility, often higher cost out of network.
What is coordination of benefits?
Determines primary and secondary payer when a patient has more than one insurance.
What is eligibility verification?
Confirming active insurance coverage and benefits before service.