Health Care Vocab

Premium

Agreed upon fees paid for coverage of medical benefits for a defined benefit period. Premiums can be paid by employers, unions, employees, or shared by both the insured individual and the plan sponsor.

Deductible

A deductible is the amount an insured person must pay each year for medical expenses before the insurance policy begins to pay.

Co-Payment

The co-payment is the fixed-dollar amount which is due and payable by the member at the time a covered service is provided.

Co-insurance

Co-insurance is the percentage of the allowed amounts for covered services that the insurance company will pay after you meet your deductible.

Private Care

Employer-sponsored coverage or health insurance purchased by an individual or family on the private market.

Managed Care

Managed care is a health care delivery system, comprising of a spectrum of financial and structural relationships among purchasers, insurers, providers and members. It is designed to favorably affect the balance of access, cost, and quality of health care for a defined population of subscribers and members.

Preventative Care

Preventative care is routine health care that includes check-ups, patient counseling, and screenings that are designed to prevent illness, disease, and other health-related problems.

Cost Sharing

Cost-sharing is a method of dividing the cost of healthcare among consumers, insurance companies, employers and providers.

Employer Sponsored Coverage

This system is used in businesses for the employees. The employer contracts with an insurance provider at a specified premium. The employer my cover part or all of this premium cost.

Mandated Employer Insurance

Requirement from a state or federal government that all employers in that jurisdiction provide health benefit coverage to employees.

COBRA

COBRA is federal law which requires each group health plan to allow employees and certain dependents to continue their group coverage after it would normally end. Coverage is extended for a stated period of time following a qualifying event, such as reduced work hours, death or divorce of a covered employee, and termination of employment.

Preferred Provider Organization (PPO)

PPO is a health plan that contracts with various physicians and hospitals. Enrollees are offered a financial incentive to use providers on a preferred list, but many use non-network providers as well.

Health Maintenance Organization (HMO)

HMO is a type of health care plan under which the enrollees receive all the medical services they need through a specific group of participating doctors and hospitals.

Health Savings Account

Health savings accounts are personal savings account made available to those enrolled in a qualified high-deductible health plan. Funds are tax-free, tax deductible and may only be used for qualified health services.

Fee-for-Service Plan

Traditional type of health insurance in which an insurer pays a health care provider a specific payment for each service rendered for a covered individual. Fee-for-service plans generally require monthly premiums, deductibles and other forms of cost-sharing.

Primary Care Provider

Health care professional who provides a basic care, including general family checkups and internal medicine.

Universal Health Insurance

This is a system in which all residents of a state, country or other geographic area have access to health care.

Single-payer System

Single-payer system is when the health care system in which one entity -- usually a government -- is the single payer for all health care services, using revenue from taxation.

Third-party Payer

The third-party player is any organization, such as a private health insurer, Medicare or Medicaid, that pays for some of the health care expenses of its enrollees.

Subsidized Health Insurance

Subsidized health insurance is health care in which the government pays for a portion of health services.

Medicare

Medicare is federal health insurance program for individuals over age 65 and the disabled. There are no financial or income eligibility requirements.

Medicaid

Medicaid is insurance program funded jointly by the federal and state governments for individuals and families with limited incomes or resources. Each state determines its eligibility requirements.

Uninsured

Individuals with no health insurance coverage. They are usually people who are unable to access adequate medical care without depriving themselves or their dependents of the essentials of living. They could also be those whose clinical condition makes them medically uninsurable.

Underinsured

Underinsured people have some form of health insurance, but lack the financial protection needed to cover out-of-pocket medical care expenses. This includes individuals who are insured all year but whose medical expenses are greater than of their annual income or whose health plan deductibles are greater than of their annual income.

Questions for today.

1. What constitutes basic health care?

2. Do Americans have a right to health care?

3. Assuming that basic health care is a right, what responsibilities come with that right?

4. With treatment costs for chronic diseases continuing to rise, does the government have the right to ban unhealthy behaviors such as smoking in exchange for basic coverage?

5. Using the vocabulary and the previous questions, what might universal health insurance look like in the United States? Detail your plan below.