Healthcare terms can often be confusing. The jargon and acronyms are not always easy to understand, and it can affect your ability to make decisions about the care you receive. Here are a few examples.

Insurance Terms

  • Premium: The amount an employer or an individual pays each month to receive insurance coverage
  • Benefit: How much of your care is covered in terms of costs and services by insurance
  • Deductible: The specified amount of money you must pay out of pocket before your insurance company will pay a claim
  • Network: A group of healthcare providers (doctors, hospitals etc.) that insurance companies work with to provide discounted services to you, if you are insured through the network. You will typically pay less for care received by an “in network” provider.

17 April TKS Healthcare terminology

  • Health maintenance organization (HMO): When you choose an insurance plan through an HMO, you would receive care through one local, in-network primary care physician who coordinates additional care with specialists as necessary. These plans typically have lower costs, but out-of-network care usually isn’t covered.
  • Preferred Provider Organization (PPO): This type of insurance plan provides more flexibility than an HMO when picking a doctor or hospital that is not in your network. PPO plans tend to have higher premiums and may even require you to hit a deductible on out-of-pocket costs. 
  • Co-pay and coinsurance: Both co-pay and coinsurance are situations where you and your insurance company together are responsible for paying for services. Co-pays are flat fees, but coinsurance is typically a percentage of the cost you are responsible for paying for a health service or prescription drug after you have reached your deductible. Both are predetermined by your insurance, and if you are not sure what they are, you should call the number on the back of your insurance card to ask. 

Healthcare Services

  • Healthcare Provider: A provider is any licensed medical professional who provides your care, whether it is a doctor, dentist, therapist, optometrist, nurse practitioner, midwife, social worker or anyone else authorized to provide services in the state in which he or she practices.
  • EHR or EMR: Electronic health records and electronic medical records both refer to the digital record of your medical information in a healthcare provider’s electronic system.
  • Home Care: Home care allows you to receive care at home, whether you’re recovering from an injury or illness, or your condition requires preventive visits to avoid a return to the hospital. Home care services must be ordered by your primary physician and include three levels of care:
    • Home health, which is skilled nursing and rehabilitation care, social services and education on your condition and medication for you and your loved ones.
    • Personal home care assistance, which is non-medical assistance with tasks around the home, such as light cleaning, food preparation, help with errands or transportation. This type of care is typically covered through private pay.
    • Community care, which is similar to personal home care assistance, and ordered by your physician when you have trouble with daily activities. These services may be covered by Medicaid or offered to veterans or those with limited income.

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  • Respite care: Respite care is an option for caregivers to receive assistance in caring of a loved one for hours or days at a time. This care may be offered in your loved one’s home or in a healthcare facility, depending on the length of your respite.

Understanding the often confusing terms of healthcare and insurance is important in navigating your care decisions. If you have a healthcare question, call 1.866.KINDRED to speak with a Registered Nurse 24 hours a day, seven days a week. Our RNs listen to your unique situation and help answer questions you may have. 

By Margaret Schmidt