Understanding the Health Care Jargon

When reading health insurance materials or listening to all the talk about “Obamacare,” it is easy to get confused very quickly. Yet, in order to receive the best healthcare possible and to know what one will be paying, one must understand what all the terminology means. Unfortunately, this is not typically something they teach in school.

This entry will deal with words often thrown around the health care world. Below, there will be concise and easy-to-understand explanations for what the various terms mean. If one is in need of further explanations, consulting with one’s health insurance carrier or talking to a health care provider can often enlighten one.

This entry is broken down into health insurance terms, Affordable Care Act terms, and general medical terms that relate to your health care. The following terms will be covered:

  • Copay
  • Coinsurance
  • Deductible
  • Out of pocket
  • Premium
  • Medicare
  • Medicaid
  • Affordable Care Act
  • Pre-existing condition
  • Insurance exchange
  • Dependent coverage
  • Cancellation
  • Lifetime limit
  • History
  • Etiology

Health Insurance Terms

One of the first health insurance terms one hears when entering a doctor’s office is copay. Copay is short for copayment. This term refers to a typically flat rate that is due at the time of an office or emergency room visit.

A related term is coinsurance. Though it is sometimes used interchangeably with copay, it is different. Coinsurance is a percentage of the medical bill that a policy holder pays once the policy’s deductible has been reached.

The term deductible is used often in health insurance and can be one of the main factors in determining insurance costs. This refers to the amount of money that must be paid out of pocket before the insurer will start paying any expenses.

As it may suggest, the phrase “out of pocket” refers to the amount of money an insured person must pay directly to the health care provider. These are expenses not covered by the insured’s insurance policy.

COBRA stands for Consolidated Omnibus Budget Reconciliation Act of 1985. COBRA most often refers to the program that guarantees the extension of health insurance coverage for up to 18 months if under a broad range of qualifying events (such as losing a job) one loses his coverage.

A premium is the amount of money one pays to receive insurance coverage. If a person works for a company that provides health insurance for its employees, then the amount the company pays the insurer is the premium.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was an act created to protect the privacy of patients seeking out treatment. It was also created to make the exchange of health coverage data more efficient and secure.

Medicare is a government assistance program for people over the age of 65. Medicare guarantees that those people will disabilities will still have access to health insurance.

Medicaid is a government assistance program geared toward helping those with low incomes and resources gain access to health insurance.


Affordable Care Act Terms

The Patient Protection and Affordable Care Act, which is also known as the Affordable Care Act (ACA) or “Obamacare,” is the most significant regulatory overhaul of the United State health care system since the 1965 passage of Medicare and Medicaid. Many of its provisions go into effect in 2014.

As the name might suggest, a pre-existing condition is a health issue one may have before receiving insurance coverage, and thus it is not covered by the insurance plan. Under the ACA, insurance companies cannot discriminate based on pre-existing conditions.

The ACA establishes state-based health insurance exchanges. This is an online marketplace where individuals and small businesses can purchase private insurance plans for themselves or their employees.

Dependent coverage is more of a general health insurance term. It is included here because the ACA requires all insurance plans that provide coverage for the dependents of its policyholders must make the coverage available until the adult child reaches 26.

Before the ACA, one could experience a cancellation of his policy if a health insurance company determined he made a mistake on his application. With the ACA, this is no longer allowed, though a plan can be cancelled if information is falsified.

Lifetime limit is another term that is going extinct with the ACA. It refers to a limit on how much a health insurance company will pay out on an individual’s plan in his lifetime. Yearly limits are also going to the wayside.

General Medical Terms

History, as it relates to one’s medical care, is an over-arching term referring to one’s personal medical history, his family’s health history, and the history for current symptoms. All of this information is used by a doctor to make diagnoses.

Etiology is just a fancy way of saying the cause of a disease or condition. For example, the etiology of that rash is the poison ivy one was rubbing.


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