Across
- 1. (Civilian Health and Medical Program of the Uniformed Services) A health plan that serves the dependents of active duty military personnel and retired military personnel and their dependents.
- 4. A healthcare system that includes the entire range of healthcare services from out-patient to hospital and long-term care.
- 6. The amount paid periodically to buy health insurance coverage. Employers and employees usually share the cost of premiums.
- 7. A person's healthcare costs are paid by their insurance or by the government
- 10. The services that members are entitled to receive based on their health plan
- 12. An insurance program for people with low incomes who are unable to afford healthcare. Although funded by the federal government, Medicaid is administered by each state. Following very broad federal guidelines, states determine specific benefits and amounts of payment for providers.
- 13. Measures of the effectiveness of particular kinds of medical treatment. This refers to what is quantified to determine if a specific treatment or type of service works.
- 16. The amount of money, or value of certain services (such as one physician visit), a patient or family must pay before costs (or percentages of costs) are covered by the health plan or insurance company, usually per year.
- 17. A group of affiliated contracted healthcare providers (physicians, hospitals, testing centers, rehabilitation centers etc.), such as an HMO, PPO, or Point of Service plan.
- 18. a person's ability to obtain healthcare services
- 20. The specific services and procedures covered by a health plan or insurer.
Down
- 2. A federal program of medical care benefits created in 1965 designed for those over age 65 or permanently disabled. Medicare consists of two separate programs: A and B. Medicare Part A, which is automatic at age 65, covers hospital costs and is financed largely by employer payroll taxes. Medicare Part B covers outpatient care and is financed through taxes and individual payments toward a premium.
- 3. The person in a managed care organization, often a primary care provider, who controls a patient's access to healthcare services and whose approval is required for referrals to other services or other specialists.
- 5. A "cap" or limit on the amount of services that may be provided. It may be the maximum cost or number of days that a service or treatment is covered.
- 8. A medical condition that starts suddenly and requires immediate care.
- 9. The responsibility for profiting or losing money based on the cost of healthcare services provided. Traditionally, health insurance companies have carried the risk. Under capitation, healthcare providers bear risk.
- 11. A list of medications that a managed care company encourages or requires physicians to prescribe as necessary in order to reduce costs.
- 14. How many times people use particular healthcare services during particular periods of time.
- 15. A person who has been admitted to a hospital or other health facility, for a period of at least 24 hours.
- 19. A percentage of providers' fees that managed care companies hold back from providers which is only given to them if the amount of care they provide (or that the entire plan provides) is under a budgeted amount for each quarter or the whole year.