This glossary explains terms in the Medicare program.
Health care provider
A person or organization that's licensed to give health care. Doctors, nurses, and hospitals are examples of health care providers.
Legal entitlement to payment or reimbursement for your health care costs, generally under a contract with a health insurance company, a group health plan offered in connection with employment, or a government program like Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).
Health Insurance Marketplace
A resource where individuals, families, and small businesses can learn about their health coverage options; compare health insurance plans based on costs, benefits, and other important features; choose a plan; and enroll in coverage. The Marketplace also provides information on programs that help people with low to moderate income and resources pay for coverage. This includes ways to save on the monthly premiums and out-of-pocket costs of coverage available through the Marketplace, and information about other programs, including Medicaid and the Children’s Health Insurance Program (CHIP). The Marketplace encourages competition among private health plans, and is accessible through websites, call centers, and in-person assistance. In some states, the Marketplace is run by the state. In others it's run by the federal government.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
The "Standard for Privacy of Individually Identifiable Health Information (also called the "Privacy Rule")" of HIPPA assures your health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care and to protect the public's health and well being.
High-deductible Medigap policy
A type of Medigap policy that has a high deductible but a lower premium. You must pay the deductible before the Medigap policy pays anything. The deductible amount can change each year.
To be homebound means:
- You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury, or
- Leaving your home isn't recommended because of your condition, and you're normally unable to leave your home because it's a major effort
You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.
Home health agency
An organization that provides home health care.
Home health care
Health care services and supplies a doctor decides you may receive in your home under a plan of care established by your doctor. Medicare only covers home health care on a limited basis as ordered by your doctor.
A special way of caring for people who are terminally ill. Hospice care involves a team-oriented approach that addresses the medical, physical, social, emotional, and spiritual needs of the patient. Hospice also provides support to the patient's family or caregiver.
Hospital outpatient setting
A part of a hospital where you get outpatient services, like an emergency department, observation unit, surgery center, or pain clinic.
Hospital-related medical condition
Any condition that was treated during your qualifying 3-day inpatient hospital stay, even if it wasn't the reason you were admitted to the hospital.
This glossary explains terms in the Medicare program, but it isn't a legal document. The official Medicare program provisions are found in the relevant laws, regulations, and rulings.