Healthcare Basics

Health insurance provides coverage for medication, doctor and emergency room visits, hospital stays, medical equipment, and other medical expenses.

The two main publicly funded health care programs are Medicare, which provides health services to people over 65 years old as well as people who meet other standards for disability, and Medicaid, which provides services to people with very low incomes who meet other eligibility requirements.

The two main publicly funded health care programs are Medicare, which provides health services to people over 65 years old as well as people who meet other standards for disability, and Medicaid, which provides services to people with very low incomes who meet other eligibility requirements.

In-Network Providers: health care providers who are contracted with your health insurance plan to provide services at a contracted or discounted rate.

Out-of-Network Providers: health care providers who are not contracted with your health insurance plan. Out-of-network coinsurance usually costs you more than in-network coinsurance because there is no contracted or discounted rate.

Premium: The amount paid for your health insurance every month. In addition to your premium, you usually have to pay other costs for your health care, including a deductible, copayments, and coinsurance.

Deductible: The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.

Copayment: A fixed amount ($20, for example) you pay for a covered health care service after you’ve paid your deductible.

Coinsurance: The percentage of costs of covered health care service you pay (20%, for example) after you’ve paid your deductible.

Out-of-pocket maximum: The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits.

Scope of practice is defined as services that a trained health professional is deemed competent to perform and permitted to undertake according to the terms of their professional license. Scope of practice provides a framework and structured guidance for activities one can perform based on their license.

Primary care promotes wellness and prevents disease.

Secondary care occurs when a person has contracted an illness or injury and requires medical care.

Tertiary care addresses the long-term effects from chronic illnesses or conditions with the purpose to restore a patient’s maximum physical and mental function.

Negligence is conduct that is careless or doesn’t provide the standard of care that a reasonable person would use.

Malpractice is a more specific term that relates to licensed professionals that fail to meet a standard of care.

HIPAA was enacted in 1996 and was prompted by the need to ensure privacy and protection of personal health records and data in an environment of electronic medical records and third-party insurance payers.

I didn’t see where this is, but I think it is informing that certain people can have access to their information if they give permission.