Healthcare Terms You Need To Know…

Affordable Care Act (ACA) –
sometimes referred to as Healthcare Reform or Obamacare, the ACA is a controversial new law that was enacted by Congress in 2008. For individuals, the law grants access to health insurance for people that didn’t have it before, consumer protections that remove annual and lifetime limits and require plans to include preventive services coverage, and consumer requirements that mandate everyone have insurance coverage.
Accountable Care Organizations (ACO) –
health care providers that coordinate care and provide chronic disease management. Hospitals and doctors’ payments from insurance carriers and/or Medicare is tied to meeting healthcare quality goals and outcomes that result in cost savings.
Consumer Directed Health Plans (CDHP) –
a CDHP combines a high-deductible health plan with a health savings account (HSA) or health reimbursement arrangement (HRA). The premiums for these types of plans are usually lower because the deductibles are high: minimum deductible of $1,200 for an individual and $2,400 for a family. Almost 15 million people are now insured by a CDHP.
Essential Health Benefits –
all individual and small group insurance plans starting in 2014 must include ‘‘essential health benefits.’’ These benefits include outpatient care, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse disorder services, behavioral health treatment, prescription drugs, rehabilitative services, laboratory services, preventative care and pediatric services, including oral and vision care for children.
Evidence-Based Practice –
an integrated approach to treating patients based on: 1) the patient's situation, 2) the patient's goals, values and wishes, 3) the best available research evidence, and 4) the clinical expertise of the practitioner.
Healthcare Cost Transparency –
this term is new and refers to the ability of consumers to have access to medical service pricing prior to a procedure. In the past, consumers were only responsible for premiums and had low out-of-pocket costs so only insurance carriers, doctors and hospitals had pricing available to them.
Health Insurance Marketplace –
once upon a time called Health Insurance Exchanges, the Health and Human Services Department (HHS) of the federal government and overseer of putting the new ACA law into practice, decided the word “marketplace” was friendlier to consumers. The biggest obstacle to people using the federal or state marketplaces isn’t the name, though. It’s that most people don’t know about them or if they do, they’re not clear if they qualify for coverage.
About 7 million individuals nationally will quality to buy insurance from private companies on the federal or state marketplaces. There are 17 states building their own marketplaces, and the rest of the states will use the federal health insurance marketplace. Open enrollment begins on Oct. 1 for coverage that starts Jan. 1. is a government website that provides information about the federal marketplace for individuals and small businesses.
Health Exchange Health Plans –
there are four levels of plans in the federal health insurance marketplace based on costs, including: Bronze, Silver, Gold and Platinum. Each of the plans offer the same set of “essential health benefits” plus other types of coverage. The plan levels differ by monthly premium costs, how much you have to pay for prescriptions or things like hospital visits, and your total out-of-pocket costs per year. For example, if you choose the Bronze Plan you will have a lower premium payment, but have to pay a higher share of the cost of your care.
Health Spending Accounts (HSA) –
paired with a high-deductible health plan, HSAs are bank accounts for tax-exempt deposits that are to be used for IRS-approved medical expenses. They are portable when you change jobs, and roll over from one year to the next if you don’t use all the money.
Navigators –
Healthcare Reform isn’t easy for consumers to understand, and buying insurance in marketplaces will be confusing for a lot of people. Because of this, the federal and state marketplaces will have call centers staffed by “Navigators” to help individuals understand their insurance choices and costs. They will not be able to make recommendations, however. There’s nothing like a warm body when you’re in over your head.
Preventive Services –
medical services, including annual exams, vaccinations, and screenings such as mammograms and colonoscopies prevent illness and are now covered 100% in health plans due to the Affordable Care Act. There is no co-pay required for these services also. The only plans that may not have this provision are those bought before March 2010.