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Glossary of Terms

 

The Glossary of Terms below is a quick reference for some of the most commonly used terms in healthcare.

  • Co-insurance: A percentage of the bill for a healthcare service that you must pay. For example, an 80/20 co-insurance rate means that your health insurance plan pays 80% of approved health care costs and you pay 20% of the remaining costs (see out-of-pocket definition below).

  • Co-payment (co-pay): A flat amount required by many insurance plans that you must pay for each medical treatment or medicine received, such as a prescription or doctor visit, which is made in addition to your insurance provider's payment for the service.

  • Deductible: The up-front amount you must pay out-of-pocket for healthcare costs each year before your insurance plan begins covering expenses.

  • Donut hole: Most plans with Medicare Part D have a coverage gap known as the "donut hole" (also known as the Medicare Part D Coverage Gap). This means that after you and your Medicare Part D drug plan have spent a certain amount of money for covered treatment, you have to pay all out-of-pocket costs for your prescriptions, up to a yearly limit. Once you have spent up to the yearly limit, your coverage gap ends and your drug plan helps pay for covered treatment again.

  • Health Insurance Portability and Accountability Act (HIPAA): A federal law that governs the use, transfer and disclosure of certain health information. It combats waste, fraud and abuse in health insurance and health care delivery. The portability component provides American workers and their families the ability to transfer and continue health insurance coverage when they change or lose their jobs. The accountability component holds all health care providers and health care organizations accountable for protecting the confidentiality and security of protected health information (PHI) when it is transferred, received, handled, or shared and applies to all forms of PHI, including paper, oral, and electronic.

  • Medicaid: United States health insurance program available to individuals who demonstrate need based on income and asset standards. It is jointly funded by states and the federal government, but is administered on the state level. Medicaid eligibility and benefits differ by state. PAN will cover patients with Medicaid.

  • Medicare: United States federal government-funded health insurance available to people who are 65 years of age and over and U.S. citizens, or have been permanent legal residents for at least five years. Those under 65 years of age can become eligible if they receive Social Security Insurance. PAN will cover patients with Medicare.

  • Medicare Part D: Also known as the Medicare Prescription Drug Benefit, Medicare Part D is a U.S. federal government program to subsidize the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries.

  • Out-of-pocket costs: Expenses you must pay when a treatment or service is not covered by your insurance. For example, travel expenses to/from your doctor, child care for when you are at the doctor, doctor visits, lab testing, X-rays, medications and more.

  • Premium: An amount that must be paid to buy into a health insurance plan. You and/or your employer would pay premiums on an agreed-upon schedule.

  • Social Security Disability Insurance (SSDI): If you are under 65 years of age, have a serious physical or mental condition that is expected to last at least 12 months and worked at a job that paid social security taxes. For more information visit the Social Security Administration's website.