News You Can Use: Health Care Glossary

Medicaid: A joint federal and state program that provides hospital and medical expense coverage to low income populations and certain elderly and disabled individuals.

Medicare: A federal government program established under Title XVIII of the Social Security Act of 1965 to provide hospital expense and medical expense insurance to the elderly and disabled. Medicare Part A is hospital insurance, and Part B is medical insurance. There is no premium required for Part A, but there is a monthly premium for Part B. Medicare Part C, or Medicare + Choice, includes coordinated care plans such as HMOs and PPOs. Medicare Part D plans are private insurance plans that help cover the cost of prescription drugs.

Over-the-counter drug: A drug product that does not require a prescription under federal or state law.

Preferred Provider Organization (PPO): A health benefits plan that lets members choose any provider without designating a primary care physician but offers benefit incentives to members who choose "preferred" or in-network physicians or hospitals.

Preventive Care: Health care that emphasizes prevention, early detection and early treatment, thereby reducing the costs of health care in the long run. Health care that seeks to prevent or foster early detection of disease and morbidity, and focuses on keeping patients well in addition to helping them while they are sick.

Primary Care: Basic or general health care usually rendered by general practitioners, family practitioners, internists, obstetricians and pediatricians, who are often referred to as primary care practitioners or PCPs. Professional and related services administered by an internist, family practitioner, obstetrician-gynecologist or pediatrician in an ambulatory setting, with referral to secondary care specialists, as necessary.

Tiered co-payments: A pharmacy benefit system where a member pays one co-payment amount for a generic drug and a higher co-payment amount for a brand-name drug. There are many variations of tiered co-payment and co-insurance designs.

Underinsured: People with public or private insurance policies that do not cover all necessary health care services, resulting in out-of-pocket expenses that exceed their ability to pay.

Universal Coverage: A type of government sponsored health plan that would provide health care coverage to all citizens. This is an aspect of Clinton's original health plan in the mid-1990s, and is an attribute of national health insurance plans similar to those offered in places such as the United Kingdom or Canada.

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