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Medical Insurance Terms
Medicare
Medicare is the federal health insurance program for Americans age 65 and older and for certain disabled Americans. If you are eligible for Social Security or Railroad Retirement benefits and are age 65, you and your spouse automatically qualify for Medicare.
Medicare has two parts:
- Hospital Insurance (Part A)
- Supplementary medical Insurance (Part B) which provides payments for doctors and related services and supplies ordered by the doctor.
If you are eligible for Medicare, Part A is free, but you must pay a premium for Part B
HMO (Health Maintenance organization)
A health maintenance organization (HMO) is a prepaid health plan. As an HMO member, you pay a monthly premium. In exchange, the HMO provides maintenance care for you and your family, including doctors visits, hospital stays, emergency care, surgery, lab tests, x-rays, and therapy.
HMO arranges for this care either directly in its own group practice and/or through doctors and other health care professionals under contract. Usually, your choices of therapy, diagnosis, doctors and hospitals are limited to those that have agreements with the HMO to provide care. However, exceptions are made in emergencies or when obviously medically necessary.
In some HMOs, doctors are salaried and they all have offices in an HMO building at one or more locations in your community. In others, independent groups of doctors contract with the HMO to take care of patients. These are called individual practice associations (IPAs) and they are made up of private physicians in private offices who agree to care for HMO members. You select a doctor from a list of participating physicians that make up the IPA network. If you are thinking of switching into an IPA-type of HMO, ask your primary doctor if he or she participates in the plan.
In almost all HMOs, you either are assigned or you choose one doctor to serve as your primary care doctor. This doctor monitors your health and provides most of your medical care, referring you to specialists and other health care professionals as needed. You usually cannot see a specialist without a referral from your primary care doctor who is expected to manage the care you receive
Kaiser Permanente is the largest non-profit HMO in the . It was founded in 1945 by industrialist Henry J.Kaiser
