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30 Terms
1
Premium
The amount you pay for your health insurance every month.
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2
Deductible
The amount you pay each year before your plan starts to pay for covered medical expenses.
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3
Co-Insurance
Cost sharing requirement where you pay a percentage and the insurance company pays the remaining percentage for covered medical expenses after the deductible is met.
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4
Co-Payment
A specific flat fee you pay for each medical service, usually for office, ER, urgent care visits, etc.
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5
Out of Pocket Max
Maximum amount you pay for covered medical expenses in a given year.
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6
HMO
Health Maintenance Organization; a more restricted and managed care plan requiring a primary care physician (PCP) as gatekeeper.
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7
PPO
Preferred Provider Organization; offers less managed care and does not require referrals to see specialists.
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8
EPO
Exclusive Provider Organization; similar to PPO but does not cover out-of-network care.
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9
POS
Point of Service; combines features of HMO and PPO, requiring referrals to see specialists.
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10
FFS
Fee-For-Service; provides high flexibility and does not require a PCP or referrals.
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11
HDHP
High Deductible Health Plan; offers lower premiums but higher out-of-pocket costs until deductibles are met.
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12
HSA
Health Savings Account; allows individuals to save money tax-free for qualifying medical expenses.
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13
Catastrophic Health Plan
Designed for young, healthy individuals emphasizing coverage for serious illnesses.
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14
Moral Hazard
The tendency of insured individuals to take greater risks, knowing they are covered.
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15
Adverse Selection
A situation where those who are more likely to use insurance are also more likely to seek it.
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16
Medicare
A federal health insurance program primarily for individuals aged 65 and older.
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17
Medicaid
A state and federal program providing health coverage for eligible low-income individuals.
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18
CHIP
Children's Health Insurance Program; provides health coverage to children in families with incomes too high for Medicaid.
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19
Entitlement Program
A government program guaranteeing access to benefit for members of a specific group based on established rights.
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20
Block Grant
A grant from the central government which a local authority can allocate to a wide range of services.
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21
Vaccine Preventable Diseases
Diseases that can be prevented by vaccines, highlighting the need for herd immunity.
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22
Herd Immunity
When a significant portion of a population is vaccinated against a contagious disease, protecting those who are not vaccinated.
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23
Palliative Care
Care focused on providing relief from the symptoms and stress of serious illness.
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24
Hospice Care
A type of palliative care for patients with terminal illnesses prioritizing comfort.
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25
Advance Directive
A written document stating your wishes regarding medical care if you cannot communicate them.
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26
Social Determinants of Health
Conditions in which people are born, grow, live, work, and age that affect health outcomes.
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27
Health Disparities
Avoidable unfair differences in health status seen within and between populations.
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28
Health Inequities
Systematic differences in health outcomes and determinants that affect socially disadvantaged groups.
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29
Income Inequality
The unequal distribution of income and opportunity between different groups in society.
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30
Cost Control Strategies
Methods implemented to manage and reduce the costs of healthcare services.
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