As you look forward to your release, we want to help you prepare by connecting you to necessary healthcare resources and education. The best way to ensure that you get the right information for you is to contact us or set up an appointment. For some basic terms and FAQs regarding Medicaid insurance, check out our glossary below.
Glossary of Health Insurance Terms
Here are some words you might hear when talking about insurance or your health care, listed in alphabetical order. This isn’t an exhaustive list, so if something you’re looking for is not here, refer to the full glossary on HealthCare.gov, or speak to your healthcare provider.
Case worker or case manager: A professional (usually a social worker) who continually helps someone arrange and evaluate their health care appointments.
Children’s Health Insurance Program (CHIP): Similar to Medicaid, this is a government program that provides low-cost health care coverage to children in families that earn too much for Medicaid (Source: Mental Health Association of Southeast Pennsylvania).
Co-pay: A fixed price for a specific medical service
Deductible: An amount that health care costs must exceed before insurance starts paying.
Dependent: A dependent (usually a spouse or a child) of an insured person who is eligible for insurance coverage (Source: Mental Health Association of Southeast Pennsylvania).
Managed Care Organization (MCO): A group of medical service providers that is covered by Medicaid insurance
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 (source).
Medicare: A federal health insurance program for people 65 and older and certain younger people with disabilities. It also covers people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD) (source).
Your network: The health-care providers, clinics, and hospitals that your insurance covers.
Nurse Practitioner (NP): A nurse with advanced education who can prescribe medication, run tests, and perform more procedures than registered nurses (RNs).
Premium: Amount you pay for insurance every month.
Preventative services: Routine health care that includes screenings, check-ups and patient counseling to prevent illness, disease, or other health problems or to detect illness at an early stage, when treatment is likely to work best. Preventative care can include services like flu and pneumonia shots, vaccines, and screenings like mammograms, depression/behavioral health screenings, or blood pressure tests (Source: Mental Health Association of Southeast Pennsylvania).
Pre-existing condition: Any condition a person received medical treatment for prior to enrollment in a new health insurance plan (Source: Mental Health Association of Southeast Pennsylvania).
Primary-care provider: A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of health care services (source).
Specialist: A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care (source).