Glossary - Know exactly like a health insurance expert!

What is HEALTH CARE FINANCING ADMINISTRATION?
The Health Care Financing Administration (HCFA), part of the
Department of Health and Human Services, administers Medicare
and Medicaid with the assistance of Social Security
Administration offices throughout the country. The HCFA
establishes the standards medical providers and organizations
must meet to be certified as qualified Medicare providers.

What is HEALTH MAINTENANCE ORGANIZATIONS (HMOS)?
These are health plans that contract with medical groups to
provide a full range of health services for their enrollees at a fixed
pre-paid, per-member fee. There are three different kinds of
HMOs:

• Group model HMOs contract with independent
groups of physicians that provide coordinated care
for large numbers of HMO patients for a fixed, permember
fee. These groups will often care for the
members of several HMOs.
• Staff model HMOs employ salaried physicians and
other health professionals who provide care solely
for members of one HMO.
• Independent Practice Associations (IPA) contract
with groups of independent physicians who work in
their own offices. These independent practitioners
receive a per-member payment or capitation from
the HMO to provide a full range of health services
for HMO members. These providers often care for
members of many HMOs.

A growing number of HMOs now offer a Point of Service (POS)
option. These “escape hatch” plans allow HMO members to seek
care from non-HMO physicians, but the premiums for POS plans
are more costly than those for traditional HMOs. Moreover, when
an HMO member receives care from a non-participating physician
or hospital, the HMO pays far less than its usual 100% coverage
of necessary medical services.

What is HEALTH INSURANCE PLAN?
This term includes an HMO, Preferred Provider Organization
(PPO), or traditional health insurance plan that covers a set range
of health services.

What is HOME HEALTH CARE?
Home Health Care is care received at the patient’s home, such as
part-time skilled nursing care, speech, physical or occupational
therapy, or part-time services of home health aides.

What is HOSPICE CARE?
Hospice Care refers to nursing services provided to the terminally
ill. It is offered in a hospice, a nursing home, or in the patient’s
home where nurses and social workers can visit on a regular basis. The purpose of the care is to keep the patient comfortable
and to enable the patient to die with dignity.