Across
- 6. Charge The maximum amount a health plan agrees to pay for a covered service, regardless of what the provider bills.
- 10. The component of Medicare that covers outpatient care, doctor visits, and preventive medical services.
- 11. The set amount a patient must pay out-of-pocket for covered services before insurance begins to share the cost.
- 14. A private plan alternative to federal Medicare that bundles hospital and medical coverage, often with added benefits and network rules.
- 15. A status for providers who have negotiated discounted rates with an insurance plan, typically lowering patient expenses.
Down
- 1. A federal fee-for-service health program allowing patients to visit any approved provider nationwide without network restrictions.
- 2. A cost-sharing arrangement where the patient pays a percentage of the service cost after meeting the deductible.
- 3. The portion of Medicare covering inpatient hospital stays, skilled nursing care, and certain home health services.
- 4. Private insurance designed to cover remaining costs not paid by original Medicare, such as deductibles and coinsurance.
- 5. A fixed, predetermined fee a patient pays for a specific service at the time of care, independent of the total cost.
- 7. The annual cap on what a patient must pay for covered services, after which the insurance plan pays 100% of eligible costs.
- 8. A designation for providers who do not have a contracted rate with an insurance plan, often resulting in higher patient costs.
- 9. The Medicare benefit that provides coverage specifically for prescription medications through private plans.
- 12. Cap A limit placed by an insurance plan on the amount or number of services it will cover within a given time period.
- 13. A provision where specific services or benefits are separated from a standard plan and managed or covered independently.