Defining health care: a primer
January 13, 2013
A fixed amount you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.
The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won't pay anything until you've met your $1,000 deductible for covered services subject to the deductible. The deductible may not apply to all services.
■ Health insurance marketplace or exchange
A new transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. The marketplace will offer you a choice of health plans that meet certain benefits and cost standards.
The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.
■ Preventative services
Routine health care that includes screenings, checkups and patient counseling to prevent illnesses, disease or other health problems.
Underinsured people have some form of health insurance but lack the financial protection needed to cover out-of-pocket medical expenses. A more formal definition of underinsured individuals includes people who are insured but have at least one of the following qualifiers: 1) Medical expenses greater than 10 percent of annual income; 2) an annual income less than 200 percent of the federal poverty level and medical expenses greater than 5 percent of annual income; and/or 3) health plan deductibles equal to or greater than 5 percent of annual income.
■ Wellness program
A program intended to improve and promote health and fitness that's usually offered through the workplace, though insurance plans can offer them directly to their enrollees. The program allows your employer or plan to offer you premium discounts, cash rewards, gym memberships and other incentives to participate. Some examples of wellness programs include programs to help you stop smoking, diabetes-management programs, weight loss programs and preventative health screenings.
Sources: Agency for Healthcare Research and Quality and http://www.healthcare.gov