The maximum amount a health insurance provider will pay for a medical service. Any difference in cost is often paid by the insured individual. See Cost Sharing.

Federal agency within the Department of Health and Human Services that administers Medicare, Medicaid and the State Children's Health Insurance Program

System in which an insured person is required to pay a percentage of covered medical costs. For example, the insurance company might pay 70 percent and the beneficiary 30 percent. See Cost Sharing.

A flat fee paid by an insured individual for a covered health service. For example, the insured individual might pay $20 for a doctor visit and the insurance company would pay the rest of the bill. See Cost Sharing.

Any system in which payment for a health service is shared by the insured and the insurer. See Allowed Charge, Coinsurance, CO-payment, Deductible and Out-of-pocket Expense.

The amount an insured person must pay each year for medical expenses before the insurance policy begins to pay. Deductibles are common in fee-for-service plans and PPOs. See Cost Sharing.

A system in which an employer pays an annual premium to a health insurance provider for a health plan that is offered to employees. Employees pay a percentage of this premium to receive the health plan.

Income figure used to determine eligibility for government programs, including Medicare, Medicaid and State Children's Health Insurance Program; officially called Federal Poverty Guidelines and issued annually by the Department of Health and Human Services to determine the minimum amount an individual or family needs for food, clothing, transportation and shelter

"Traditional" type of health insurance in which an insurer pays a health care provider a specific payment for each service rendered for a covered individual. Fee-for-service plans generally require monthly premiums, deductibles and other forms of cost-sharing. They may not cover preventive and routine care.

A prescription drug that has the same active ingredients as a brand name drug and is often less expensive

A type of insurance in which a group of individuals, such as employees or university students, are covered under one insurance policy, and the premiums are the same for every person or family in the plan. See Employer-sponsored Coverage.

Type of health plan in which members pay a monthly premium for comprehensive care, including preventive and routine doctors' visits. Typically, HMOs contract or employ their own health care providers, and members must visit those doctors, except in emergencies or when medically necessary. See Managed Care.

See Health Savings Account, Medical Savings Account.

Personal savings account made available to those enrolled in a qualified high-deductible health plan. Funds are tax-free, tax deductible and may only be used for qualified health services.

An expansion of the Medical Savings Account, but unlike MSA, HSA allows everyone covered by a high deductible health plan to participate (including all size employers, the self-employed, individuals and families who are not self-employed); funding by the employer, employee or both within the same taxable year; portability; larger contributions; and broader deductible ranges. See Deductible, Medical Savings Account.

Health insurance purchased individually by a person or family; premiums vary by age, health status and other factors. See Private Coverage.

Requirement from a state or federal government that all individuals in that jurisdiction purchase private health care. In 2006, Massachusetts was the first state to implement an individual mandate. The law is scheduled to go into effect in July 2007.

Requirement from a state or federal government that all employers in that jurisdiction provide health benefit coverage to employees

Type of health care plan that integrates the payment and delivery of services to enrolled beneficiaries. Managed Care plan providers contract or employ their own health care providers. See Health Maintenance Organization.

Insurance program funded jointly by the federal and state governments for individuals and families with limited incomes or resources. Each state determines its eligibility requirements.

Programs that allow individuals and families to purchase Medicaid coverage if they otherwise earn too much income to qualify for regular Medicaid. Programs include State Children's Health Insurance Program, Children and Youth with Special Health Care Needs, and Working People with Disabilities.

Federal health insurance program for individuals over age 65 and the disabled. There are no financial or income eligibility requirements. Medicare is composed of Part A and Part B. See Medicare Part A, Medicare Part B.

Hospital insurance component of Medicare, which covers inpatient hospital stays, care in a nursing facility, hospice care and some home health care. See Medicare Part B.

Component of Medicare that is not covered by Medicare Part A; helps pay for doctors' services, outpatient hospital care and medical equipment. See Medicare Part A.

An account in which individuals, usually those self-employed, can deposit tax-deferred dollars for medical expenses. See Health Savings Account.

A country's total spending on health services, including doctor's visits, hospital care, prescriptions and over-the-counter drugs and products, nursing home care, insurance costs, public health spending, health research and construction

Health care system in which the government is the single payer for all health services, using revenue from taxation. See Single-payer System, Socialized Medicine, Subsidized Health Insurance, Universal Health Care.

Payment for health services not covered by an individual's health plan. See Cost Sharing.

The total payment for a health service. See Allowed Charge.

The ability for an individual to have continuous health coverage while moving between plans

Health plan in which enrollees use doctors, hospitals and providers that belong to the insurer's network and that agree to provide specific services for a set fee. Enrollees can use doctors, hospitals and providers outside of the network for an additional cost.

The amount paid, usually monthly, for health insurance

Insurance that covers both brand-name and generic prescription drugs at participating pharmacies

Routine health care to prevent (rather than treat) illnesses, disease, or other health problems; includes tests, pelvic exams, flu shots and screening mammograms

Health care professional who provides basic care, including general family checkups and internal medicine

Employer-sponsored coverage or health insurance purchased by an individual or family on the private market

A group, usually of states or public or private employers, that pools resources to purchase health care plans or prescription drugs from pharmaceutical companies for its citizens or employees

Free or low-cost health insurance jointly funded by the state and federal governments for uninsured children. SCHIP is intended to reach uninsured children whose families earn too much to qualify for Medicaid but not enough to get private coverage. Each state determines the design of its program, eligibility groups, benefit packages, payment levels for coverage and administrative and operating procedures.

A health care system in which one entity -- usually a government -- is the single payer for all health care services, using revenue from taxation. See National Health Insurance, Socialized Medicine, Subsidized Health Insurance, Universal Health Care.

A publicly financed and administered form of health care. There is no one definition, but often means that the government is the single payer for all health services and owns and operates health care facilities. See National Health Insurance, Single-payer System, Subsidized Health Insurance, Universal Health Care.

Health care in which the government pays for a portion of health services. See National Health Insurance, Single-payer System, Socialized Health Insurance, Universal Health Care.

Any organization, such as a private health insurer, Medicare or Medicaid, that pays for some of the health care expenses of its enrollees.

Health care or services provided by hospitals or others without payment from the patient, or government-sponsored or private insurance program

A system in which all residents of a state, country or other geographic area have access to health care. See National Health Insurance, Single-payer System, Socialized Health Insurance, Subsidized Health Insurance.