Health Insurance

A preferred provider organization (PPO) is a health insurance plan for individuals and families that involves networks made up of contracted medical professionals and health insurance companies. Health care facilities and practitioners, known as preferred providers, offer services to policyholders at reduced rates.

A health savings account (HSA) is a tax-advantaged account to help people save for medical expenses that are not reimbursed by high-deductible health plans. No tax is levied on contributions to an HSA, on the HSA’s earnings, or on distributions used to pay for qualified medical expenses.

The Children’s Health Insurance Program (CHIP) provides medical coverage for individuals age 18 and younger whose parents earn too much income to qualify for Medicaid, but not enough to pay for private coverage. Congress passed CHIP in 1997 during the Clinton administration.

A preexisting condition is a health condition such as diabetes, cancer, or heart disease, that existed prior to applying for health or life insurance. Under the Affordable Care Act (ACA), health insurance companies can’t refuse coverage or charge more for preexisting conditions.

The term Medicaid refers to a public health insurance program that provides health care coverage to low-income families and individuals in the United States. The program is jointly funded by the federal government and individual states. It is operated at the state level which means that coverage and administration vary greatly from state to state.

A Medicaid waiver can help a person live in the community in the least restrictive setting, rather than live in a nursing home or institution. Services may include case management, personal care or adult daycare, financial management, job coaching, assistive technology, personal support services, nursing care, and more.

Medicare is a U.S. government health insurance program covering primarily people age 65 or older. Medicare coverage is for particular aspects of health care, and some come at a cost for the insured. While this allows the program to offer participants more choices regarding costs and coverage, it also introduces complexity for those seeking to sign up.

An individual who needs to secure health insurance may find a variety of insurance providers with unique features. One type of insurance provider that is popular on the Health Insurance Marketplace is a health maintenance organization (HMO), an insurance structure that provides coverage through a network of physicians.

Coinsurance is the amount, generally expressed as a fixed percentage, an insured must pay toward a covered claim after the deductible is satisfied. It is common in health insurance. Some property insurance policies also contain coinsurance provisions. In this case, coinsurance is the amount of coverage that the property owner must purchase for a structure.

A flexible spending account (FSA) is a type of savings account that allows you to contribute a portion of your regular earnings before tax. Employers establish FSAs and can also contribute to employees’ accounts. Distributions from the account must be used to reimburse the employee for qualified expenses related to medical and dental services. An FSA is sometimes called a “flexible spending arrangement."

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a health insurance program that allows eligible employees and their dependents the continued benefits of health insurance coverage when an employee loses their job or experiences a reduction of work hours.

The term high-deductible health plan (HDHP) refers to a health insurance plan with a sizable deductible for medical expenses. An HDHP usually has a larger annual deductible (usually four figures, varying year to year) than a typical health plan but charges lower monthly premiums. Plans fully cover routine preventive care, which means that individuals aren't responsible for copays or coinsurance.