Health Insurance

Medicare

A federal health insurance program for people 65 and older and certain younger people with disabilities

HMO

A managed care plan where the patent must use physicians from a list of network providers in order to have the expenses paid by the insurance

Marketplace

A service that helps people shop for and enroll in affordable health insurance

Out of pocket max (or limit)

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

After john paid his $500, the insurance company covered over 80% of the remainder and john paid the remaining 20%. This is called

Co-insurance

Jane has to take her kids to the doctors for their check-ups twice a year. Each time she goes she pays $3o each visit. What is this called

Co-pay

Medicaid

Insurance program that provides free or low cost health coverage to some low income people, families, and children pregnant women the elderly and people with disabilities

PPO

Managed care plan where there is incentive to use physicians from a list of network providers. Typically the incentive is a higher co-insurance percentage

Jane had several major medical procedures in one year. By august she had paid over $10,000 and the insurance company will now pay 100% of the remainder of her medical bills for the year. This is called

Out of pocket max

Bob has $250 taken out of his paycheck each month to pay for his health insurance. This is called a

Premium

Deductible

The amount of money that an individual pays before the benefits of health insurance kick in and coinsurance starts.

Premium

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

CMS

The federal agency that runs the medicare, medicaid, and children's health insurance programs, and the federally facilitated marketplace.

Co-pay

The flat fee that an individual is expected to pay for a medical service, such as a doctor's appointment.

John had a lot of medical bills over the course of a year. His total bill was $5,600. His insurance company would not pay any of his bills until he paid $500. This is called a

deductible

Co-insurance

the percentage of money that you are expected to pay after the deductible is reach