Glossary of Terms

Accountable care organization (ACO)

An accountable care organization (ACO) is a group of health care providers who can offer
Medicare patients coordinated, high-quality care. When an ACO delivers both high-quality care and efficient health care spending, it shares in the Medicare savings.

Accreditation

For the health insurance marketplace, accreditation means that a health plan has met national quality standards.

Actuarial value

An actuarial value is the percentage of total health care costs that are paid by a health insurance plan. For example, a plan with an actuarial value of 70% pays for 70% of all enrollees' combined health care costs. You would then be responsible for paying the other 30%, through a combination of copayments, deductibles, and coinsurance.

Actuarial equivalent

Actuarial equivalent is a term used to describe two or more health plans that have the same
actuarial value. Actuarially equivalent plans will likely have different premiums and cost-sharing requirements.

Affordable Care Act (ACA)

The Affordable Care Act (ACA), commonly referred to as Obamacare, is the health care reform law enacted in March 2010 that will start to take effect in January 2014. The ACA helps put you in control of selecting and managing your insurance coverage. It includes reforms such as guaranteed coverage regardless of your health status.

Affordable coverage (for individuals and families)

Affordable coverage is a term that relates directly to the individual mandate. If you would have to spend more than 8% of your household income on insurance, there would be no fee if you decide to go without insurance.

Agent

Agents can help you through the complexities of purchasing and enrolling in health insurance coverage to get the best price based on specific situations and needs. Also, agents can act as advisors when you need help with claims processing. Agents are paid a commission for their work, and they are licensed and regulated by states.

Allowed amount

Allowed amount is the maximum amount an insurance company will pay for your covered health care services. If services cost more than the allowed amount, then you may have to pay the difference.

American Indian or Alaska Native

An American Indian or Alaska Native is someone from any of the original peoples of North and South America (including Central America) who maintains tribal affiliation or community attachment. American Indians and Alaska Natives are eligible for additional benefits under the Affordable Care Act.

Annual deductible combined

Within a Health Savings Account (HSA), an annual deductible combined is the total amount you must pay out of pocket before the health plan begins to cover the costs.

Annual limit

An annual limit is a cap on the benefits your insurance company will pay toward services in a coverage year. It can be placed on the costs of a service or on the number of visits for a service. Once you reach your annual limit, your carrier will not cover additional services until the beginning of the next plan year.

Appeal

As it relates to a health insurance marketplace, an appeal is a request to review a decision made about your eligibility. An appeal can also be a request for your carrier to review a decision or grievance

Association health plan

An association health plan is a health insurance plan that is offered to members of an association. Depending on how an association health plan is structured, it could be largely exempt from regulations.

Authorized representative

An authorized representative is a person—such as a guardian or an individual who has power of attorney—who can help make decisions for you, including enrolling in a health coverage plan, handling claims and payments, and signing the application on your behalf.

Balance billing

Balance billing is when a provider bills you for the difference between their charge and the
allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30.

Basic Health Program (BHP)

Under the Affordable Care Act, states have the option to implement a Basic Health Program (BHP) that would offer affordable insurance coverage for low-income residents. The program would provide continued care for people with incomes that move between Medicaid eligibility and eligibility for tax credits to get coverage through the state's health insurance marketplace.

Benefits

Benefits refer to health care services that are covered by your health plan.

Broker

Agents, sometimes referred to as brokers, can help you through the complexities of purchasing and enrolling in health insurance coverage to get the best price based on specific situations and needs. Also, agents can act as advisors when you need help with claims processing. Agents are paid a commission for their work, and they are licensed and regulated by states.

Capitation

A capitation is a method of paying for health care services where providers receive a set payment for each person instead of receiving payment based on the number of services provided or the costs of the services.

Carrier

A carrier is a licensed company that provides you with health and/or dental insurance coverage. A carrier may also be referred to as an "insurer" or "insurance company."

Case management

Case management is the process of coordinating medical care for patients with specific diagnoses or high health care needs. Case managers can be physicians, nurses, or social workers.

Catastrophic plan

Catastrophic plans are designed to provide you with an emergency safety net to protect against high, unexpected medical costs. Although these plans have lower monthly premiums, they require you to pay full price for most of your health care services until you reach your out-of-pocket limit. Catastrophic plans are only available if you are under 30 years old, or if you would have to spend more than 8% of your household income on a bronze plan.

Children's Health Insurance Program (CHIP)

The Children’s Health Insurance Program (CHIP) can provide health coverage for your children if they aren’t eligible for Medicaid, and if your family can’t afford private insurance. CHIP is administered by each state and jointly funded by the federal and state governments.

Chronic care management

Chronic care management is the coordination of both health care and supportive services to improve the health status of patients with chronic conditions, such as diabetes and asthma.

COBRA

COBRA is a type of continuation coverage that allows you to continue your health coverage offered through an employer, even if you have changed or lost a job, or experienced a change in your eligibility status.

Coinsurance

Coinsurance is a form of cost-sharing required by some insurance plans. Coinsurance is the percentage you would have to pay if you receive a covered health care service. If your insurance plan requires 20% coinsurance, you would pay 20% of the allowed amount for a covered health care service. The insurer would pay the rest of the allowed amount.

Community rating

Community rating is a method for setting premium rates for health insurance plans. With community rating, all enrollees of an insurance plan are charged the same premium regardless of their age, gender, or health status.

Consumer-directed health plan

A consumer-directed health plan helps increase awareness about health care costs and gives incentives for considering costs when making health care decisions. These health plans usually have a high deductible accompanied by a consumer-controlled savings account.

Consumer Operated and Oriented Plan (CO-OP)

A Consumer Operated and Oriented Plan (CO-OP) is a qualified health plan offered by nonprofit, customer-governed, private health insurers.

Continuation coverage

Continuation coverage allows you to temporarily continue your health coverage, even if you have changed or lost a job, or experienced a change in your eligibility status. See COBRA,
State Continuation, and portable coverage.

Coordinated care organization (CCO)

A coordinated care organization (CCO) is a network of health care providers who have agreed to work together in their local communities to serve Medicaid patients.

Copayment (copay)

Copayments are a form of cost-sharing required by some insurance plans. Also called a "copay," a copayment is a fixed dollar amount (e.g., $20) you would have to pay if you receive a covered health care service. Copayment amounts can vary depending on the type of service.

Cost-sharing

Cost-sharing refers to any expense you pay when you receive covered health care services. Cost-sharing can be in the form of deductibles, copayments, and coinsurance. These costs are above and beyond the amount you pay for your premium.

Cost-sharing assistance

Cost-sharing assistance lowers your out-of-pocket maximum and can also reduce your plan
deductibles, copayments, and coinsurance amounts.

Deductible

A deductible is a form of cost-sharing required by some insurance plans. A deductible is a fixed dollar amount (e.g., $500) you would have to pay for covered health care services before your insurance plan begins to pay for services. The deductible may not apply to all services.

Defined contribution

A defined contribution is a fixed dollar amount an employer pays toward the employee-only premium. It must be the same dollar amount for all employees.

Dependent

Dependents are typically family members. For tax purposes, dependents are people who qualify as an exemption on your tax return. For insurance purposes, dependents are any children up to the age of 26, who can remain on their parents' insurance plan.

Disability

A disability is a medical condition or impairment that limits the ability to perform normal work or life activities. Disabilities may be physical, cognitive, mental, sensory, emotional, developmental, or some combination of these.

Dual eligible beneficiaries

Dual eligible beneficiaries are individuals who are eligible for both Medicare and Medicaid.

Early and periodic screening, diagnosis, and treatment (EPSDT) services

Early and periodic screening, diagnosis, and treatment (EPSDT) services are some of the services states are required to include in their basic benefits package for all Medicaid-eligible children under age 21. EPSDT services include periodic screenings for physical and mental conditions, as well as vision, hearing, and dental problems.

Electronic health record

An electronic health record—or an electronic medical record—is a computerized record of your patient information, including medical, demographic, and administrative data.

Eligible dependent

Eligible dependents are spouses, domestic partners, or children who are eligible to enroll in the same plan as you are.

Eligible employee

For businesses, an eligible employee is someone who works a regular schedule of 17.5 hours or more per week on the date coverage is to take effect.

Employee participation rate

For businesses, an employee participation rate is the percentage of employees who enroll in an employer’s health coverage.

Employee Retirement Income Security Act (ERISA)

The Employee Retirement Income Security Act (ERISA) is a federal law that sets minimum standards for pension plans. ERISA applies to most kinds of employee benefit plans, including plans covering health care benefits.

Employer coverage

Employer coverage is the health coverage that a company provides you, and sometimes your spouses and children.

Employer Health Care Tax Credit

The Small Business Health Care Tax Credit was created under the Affordable Care Act to help encourage small businesses with fewer than 25 employees to offer group coverage. Small businesses must purchase a plan through the health insurance marketplace, cover at least 50% of the cost of health coverage for each employee. The average annual salary of all employees is less than $50,000.

Employer mandate

For businesses, an employer mandate is a requirement for employers to offer health benefits and pay a set portion of the cost of those benefits on behalf of their employees. In 2015, businesses with more than 50 full-time employees will have to offer health coverage or else pay a penalty.

Enrollment period

An enrollment period is a defined period during which you may enroll in health insurance coverage.

Entitlement program

Entitlement programs refer to federal programs, including Medicare and Medicaid. If you're eligible for these programs you have a right to benefits.

Essential health benefits (EHB)

Essential health benefits are a set of 10 health care service categories defined by the
Affordable Care Act that must be covered by certain plans beginning in 2014.

Exchange

An exchange, sometimes called a health insurance marketplace, is a new way to get health insurance under the Affordable Care Act. Starting in 2014, every state will have a marketplace where you can compare and purchase health insurance plans, and find out if you are eligible for tax credits or public programs to help pay for your health care.

Excluded services

Excluded services are health care services that are not covered by a particular health insurance plan.

Exclusive Provider Organization (EPOs)

An Exclusive Provider Organization (EPO) offers managed care plans that cover services only if you go to doctors, specialists, or hospitals in the plan’s network.

Experience rating

Experience rating is a method of setting premiums for health insurance policies based on the claims history of an individual or group.

Federal Employee Health Benefits Program (FEHBP)

The Federal Employee Health Benefits Program provides health insurance to employees of the U.S. federal government. Federal employees can choose from a menu of plans that include fee-for-service plans, plans with a point-of-service option, and health maintenance organization plans.

Federal Medical Assistance Percentage (FMAP)

The Federal Medical Assistance Percentage (FMAP) is the statutory term for the federal
Medicaid matching rate. This percentage is the share of the costs of Medicaid services or administration that the federal government covers.

Federally recognized Tribe

Federally recognized Tribes are American Indian or Alaska Native Tribes legally acknowledged by the United States Bureau of Indian Affairs.

Federal poverty level (FPL)

The federal poverty level (FPL) is the federal government's working definition of poverty that is used to determine whose income is below poverty and who is eligible for public programs.

Federally qualified health centers (FQHC)

Funded by the federal government, federally qualified health centers (FQHC) refer to safety net service providers—such as community health clinics and public housing centers—that provide health services regardless of your ability to pay.

Fee

Starting January 1, 2014, if you don't have a health plan that qualifies as minimum essential coverage, you may have to pay a fee that increases every year: from 1% of income (or $95 per adult, whichever is higher) in 2014 to 2.5% of income (or $695 per adult) in 2016.

Fee-for-service

Fee-for-service is a traditional method of paying for medical services under which doctors and hospitals are paid for each service they provide.

Grandfathered health plan

A grandfathered health plan is a group health plan that was created—or an individual health insurance policy that was purchased—on or before March 23, 2010. Grandfathered plans are exempt from many changes required under the Affordable Care Act.

Group health insurance

Group health insurance is offered to a group of people, such as employees of a company. A large number of Americans have group health insurance through their employer or their spouse’s employer.

Guaranteed issue

Guaranteed issue means that you will not be denied insurance coverage based on your health status or pre-existing conditions. Similarly, guaranteed renewal means that you can renew your existing coverage without regard to your health status or use of services.

Health care cooperative

A health care cooperative is a nonprofit, member-run health insurance organization that provides insurance coverage to individuals and small businesses, and can operate at state, regional, and national levels.

Health care provider

Health care providers are doctors and other medical professionals who help identify, treat, and prevent illness or disability.

Health care sharing ministry

Health care sharing ministries, described in section 501(c)(3) of the Internal Revenue Code, are ministries in existence continuously since December 31, 1999. Members of the ministries share medical expenses among themselves without regard to the state of residence or employment.

Health coverage

Health coverage is the payment of benefits for your covered sickness or injury. This may include dental insurance, medical insurance, vision care, as well as other benefits. See health insurance.

Health information technology

Health information technology is a set of systems and technologies that enable health care organizations and providers to gather, store, and share information electronically.

Health insurance

Health insurance is an agreement by a carrier or public health program to pay some or all of your health care costs. See health coverage.

Health insurance marketplace

A health insurance marketplace, sometimes called an exchange, is a new way to get health insurance under the Affordable Care Act. Starting in 2014, every state will have a marketplace where you can compare and purchase health insurance plans, and find out if you are eligible for a premium tax credit or public programs to help pay for your health care.

Health maintenance organization (HMO)

A health maintenance organization (HMO) is a type of insurance plan in which the insurer contracts with or directly uses a network of physicians. If you enroll in an HMO plan, you will likely be asked to choose a primary care physician from within this network, and you may need a referral before seeing a specialist.

Health reimbursement account (HRA)

A health reimbursement account (HRA) is a tax-exempt account that can be used to pay for current or future health expenses. HRAs are established benefit plans funded by employer contributions.

Health savings account (HSA)

Health savings accounts (HSAs) are tax-exempt savings accounts that you can use to pay for health care expenses outside of your health plan. Contributions to your HSA can be made by anyone, including an employer, up to an annual maximum.

High-deductible health plan

A high-deductible health plan (HDHP) is a health insurance plan with lower premiums and higher deductibles than a traditional health plan. Enrollment in an HDHP allows you to sign up for a
health savings account.

High-risk pool

High-risk pools refer to state programs designed to provide health insurance to people who are considered medically uninsurable and are unable to buy coverage in the individual market.

Hospice services

Hospice services provide comfort and support for you and your family in the last stages of a terminal illness.

Household

A household includes you, your spouse or live-in partner, any children who live with you, and anyone you include on your federal income tax return. For the purposes of premium tax credits, a live-in partner is not included in the household.

Individual mandate

The individual mandate is the provision of the Affordable Care Act that requires most people to maintain health insurance coverage starting in 2014 or else pay a fee. See fee.

In-network benefits

In-network benefits are associated with a carrier's network of doctors, hospitals, clinics, and labs that accept allowed amounts as payment in full. You typically pay lower out-of-pocket costs when using these providers.

Inpatient care

Inpatient care is medical or surgical care that requires admission to a hospital or medical facility and usually includes an overnight stay.

In-person assistance

In-person assistance refers to individuals and organizations that provide free, unbiased help to people and small businesses looking for health coverage through a health insurance marketplace.

Legally present resident

A legally present resident is a person who is not a U.S. citizen and lives under legally recognized and lawfully recorded permanent residence as an immigrant.

Lifetime benefit maximum

A lifetime benefit maximum is the cap on the amount of money insurers will pay toward the cost of health care services over the lifetime of the insurance policy.

Long-term care

Long-term care is a set of services that enable people to live independently in the community, including home health and personal care, and services provided in institutional settings such as nursing homes.

Managed care organization (MCO)

Managed care organizations (MCOs), networks, or health plans are doctors, clinics, hospitals, pharmacies, and other providers who work together to care for their specific members' health care needs.

Mandatory benefits

Mandatory benefits are benefits or services—including mental health services, substance abuse treatment, and breast reconstruction following a mastectomy—that state-licensed health insurance organizations are required to cover in their health insurance plans.

Marketplace

A health insurance marketplace, sometimes called an exchange, is a new way to get health insurance under the Affordable Care Act. Starting in 2014, every state will have a marketplace where you can compare and purchase health insurance plans, and find out if you are eligible for a premium tax credit or public programs to help pay for your health care.

Medicaid

Medicaid is a federal and state program that helps with medical costs if you have limited income and resources, and also offers coverage for aging and disability programs. States design their own Medicaid programs within broad federal guidelines.

Medicaid waiver

A Medicaid waiver allows a state to continue receiving federal Medicaid matching funds even though it is no longer in compliance with certain requirements of the Medicaid statute.

Medical home

A medical home is a place where you can receive comprehensive primary care services, have an ongoing relationship with a primary care provider, have enhanced access to non-emergency care, and have access to linguistically and culturally appropriate care.

Medical loss ratio

The medical loss ratio is the percentage of premium dollars an insurance company spends on medical care and not on administrative costs or profits. Whenever an insurance company does not spend at least a certain percentage of the prior year's health insurance premium, it must deliver a medical loss ratio rebate.

Medical underwriting

Medical underwriting is the process of determining whether or not you get health care coverage based on your medical history.

Medicare

Medicare is a federal entitlement program that provides health insurance coverage to 45 million people, including people age 65 and older, and younger people with permanent disabilities, end-state renal disease, and Lou Gehrig’s disease.

Medicare prescription drug coverage (Part D)

Medicare prescription drug coverage—also known as Medicare Part D—helps pay for prescription drugs for people with Medicare.

Metal level

Metal levels are the four levels of health insurance coverage (bronze, silver, gold, and platinum) available to individuals and groups under the Affordable Care Act. Each metal level must cover the same set of minimum essential health benefits, and it may contain additional benefits. Metal levels are based on how much you pay for your premium compared with how much you pay in out-of-pocket costs.

Modified adjusted gross income (MAGI)

Modified adjusted gross income (MAGI) is a definition of income from the tax system used to determine eligibility for Medicaid in all states, and for premium tax credits available to people buying insurance from exchanges.

Navigator

Navigators are staff members or volunteers at community partner organizations who are trained and certified to help educate you about health coverage plans. They can also assist you with the application and enrollment processes.

Network

Network facilities, providers, and suppliers contract with health insurance carriers or plans to provide health care services.

Non-preferred provider

Non-preferred providers are doctors or other medical professionals who do not have a contract with your carrier or plan. You will usually pay more to see a non-preferred provider.

Obamacare

The Affordable Care Act (ACA), commonly referred to as Obamacare, is the health care reform law enacted in March 2010 that will start to take effect in January 2014. The ACA helps put you in control of selecting and managing your insurance coverage. It includes reforms such as guaranteed coverage regardless of your health status.

Open enrollment

Open enrollment is an annual period that usually occurs shortly before the beginning of a new plan year, during which you may enroll in a private health insurance plan for the first time, make changes to an existing plan, switch carriers, or cancel your coverage. For 2014, open enrollment goes from October 1, 2013, to March 31, 2014.

Out-of-network benefits

Out-of-network benefits are associated with non-contracted health care providers. Some plans offer out-of-network benefits, but you typically pay higher out-of-pocket costs for these services and may have to file a separate claim.

Out-of-pocket costs

Out-of-pocket costs are expenses for medical care that aren’t covered or paid by your insurance plan, including deductibles, coinsurance, and copayments, plus all other costs for services that aren't covered.

Out-of-pocket maximum (OOP max)

Out-of-pocket maximum (OOP max) is the maximum amount you will have to pay in
out-of-pocket costs within a policy period. carriers will begin paying 100% of health care costs for covered benefits after the out-of-pocket maximum has been reached.

Outpatient care

Outpatient care is medical or surgical care that does not include an overnight hospital stay.

Pay for performance

Pay for performance is a health care payment system in which providers receive incentives for meeting or exceeding quality.

Payment bundling

Payment bundling is a type of payment where providers or hospitals receive a single payment for all of the care given for an illness, rather than per service.

Penalty

Beginning in 2015, businesses with 50 or more full-time equivalent employees (FTEs) will need to offer employees health coverage or will have to pay a penalty. Learn more.

Plan year

A plan year is a consecutive 12-month period during which a qualified health plan (QHP) provides coverage for health benefits. A plan year may or may not be a calendar year.

Point of service (POS) plan

A point of service (POS) plan is a hybrid of HMO and PPO plans, in which you choose a primary care physician who refers patients to specialists. You may also receive care from non-network providers, but with higher out-of-pocket costs.

Portable coverage

Portable coverage allows people to get coverage as they move from job to job or in and out of employment. Also, see continuation coverage.

Pre-existing condition

A pre-existing condition is a health problem you had before the date that new health coverage starts.

Preferred provider organization (PPO)

A preferred provider organization (PPO) is a health plan that has contracts with a network of preferred providers. You don't need to select a primary care physician or get a referral to see other providers in the network.

Premium

A premium is the amount that you must pay for health coverage. It is usually paid monthly, quarterly, or yearly.

Premium tax credit

A premium tax credit is a new tax credit created by the Affordable Care Act that can lower your monthly premium costs. If you qualify, you can apply the premium tax credit right away—up to the maximum amount—or later when you file a federal income tax return. Get more information on tax credits.

Prescription drugs

Prescription drugs and medications require a prescription from medical professionals before they can be dispensed.

Preventive care

Preventive care consists of measures taken to prevent disease or injury.

Primary care provider

Primary care providers deliver or coordinate a range of health care services for their patients.

Private health insurance

Private health insurance is coverage by a health plan provided through an employer or union or purchased by an individual from a private health insurance company. The carrier will pay some or all of your health care costs, as long as you pay the monthly premium established under the plan.

Probationary period

For businesses, a probationary period is the time period—determined by the employer—that employees must wait before becoming eligible for group benefits. Effective January 1, 2014, the Affordable Care Act does not allow this period to be greater than 90 days.

Provider

A provider is any doctor or other medical professional, or a health care facility rendering services that are licensed, certified, or accredited under the state. This includes doctors, nurse practitioners, clinical nurse specialists, physician assistants, and more.

Provider payment rates

Provider payment rates are the total payment a provider, hospital, or community health center receives when they provide medical services to a patient.

Purchasing pool

A purchasing pool is where health insurance providers pool the health care risks of a group of people in order to make the costs predictable and manageable.

Qualified health plan (QHP)

A qualified health plan (QHP) is an insurance plan (certified by an exchange) that provides
essential health benefits and follows established limits on cost-sharing.

Qualifying dependent

Qualifying dependents include a legal spouse or same-sex registered domestic partner; biological children, stepchildren, children of domestic partners, or legally adopted children up to age 26; a child who is permanently incapable of self-support due to a physical or mental handicap before reaching age 26; or a child for whom the spouse/domestic partner is a legal guardian.

Quality rating(s)

Quality ratings are scores used to rate the performance of qualified health plans (QHPs) based on consumer feedback. Part of a four-star system (one star being poor quality, four being excellent), these ratings are designed to help you make informed decisions about health coverage.

Risk adjustment

The risk adjustment program under the Affordable Care Act—along with reinsurance and risk corridors—works to stabilize insurance premiums by providing payment to plans with sicker and higher-cost enrollees.

Safety net

Safety net providers are hospitals, doctors, and clinics that provide health care services to patients regardless of their ability to pay.

Section 125 premium-only plan (POP)

A Section 125 premium-only plan (POP) legally allows employees to pay their portion of medical insurance premiums and other benefit premiums using pre-tax or tax-free dollars.

Self-funded plan

A self-funded plan is a plan where the employer assumes direct financial responsibility for the costs of medical claims.

Small Business Health Care Tax Credit

The Small Business Health Care Tax Credit was created under the Affordable Care Act to help encourage small businesses with fewer than 25 employees to offer group coverage. Small businesses must purchase a plan through the health insurance marketplace, cover at least 50% of the cost of health coverage for each employee. The average annual salary of all employees is less than $50,000.

State Continuation

State Continuation is a type of continuation coverage that allows you and your family to temporarily continue health coverage offered through an employer, even if you have changed or lost a job, or experienced a change in eligibility status.

Student health plan

A student health plan is a health plan offered by a college or university through an insurance company. These plans provide students with coverage as long as they meet certain criteria, such as credit hours.

Summary of Benefits and Coverage (SBC)

A Summary of Benefits and Coverage explains—in plain language—information about the benefits and coverage of a specific health plan. The summary should deliver consistent information from plan to plan, and must be provided to consumers by insurance companies and group health plans under the
Affordable Care Act.

TEFRA

The Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 makes Medicare a secondary payor option for employees who are 65 or above.

TRICARE

TRICARE is the federal health care program serving active and retired military service members and their families worldwide.

Unaffordable coverage (employers and employees)

Unaffordable coverage is a term that relates directly to employer coverage and the
premium tax credit. You may be able to qualify for help paying for health coverage if your employer coverage is considered unaffordable, meaning that you would have to pay more than 9.5% of your annual household income.

Uncompensated care

Uncompensated care refers to the cost of health care services that a doctor or hospital provides without ever receiving payment, typically because the patient was uninsured or under-insured and could not afford to pay.

Underinsured

Underinsured people have health insurance but face out-of-pocket health care costs or limits on benefits that may affect their ability to access or pay for health care services.

Urgent care

Urgent care is medical care reserved for an illness, injury, or condition serious enough that a person would seek care right away.

Veterans Affairs (VA)

The Department of Veterans Affairs provides patient care and federal benefits to veterans and their dependents.

Wellness plan

A wellness plan or program is an employment-based program to promote health and prevent chronic disease.

Workers' compensation insurance

Workers' compensation insurance pays for costs associated with disease or injury incurred on the job.

Young Adult Health Plan

A Young Adult Health Plan is designed to offer lower premiums in exchange for high deductibles and/or limited benefit packages.

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