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Health Insurance Terms Covering Medicare, Medicaid and Managed Care

Health Insurance Glossary Page 4

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Major Medical Benefits. The portion of a health insurance plan that provides coverage for treatment by a doctor, for same-day surgery, and for medical tests that are not covered under basic benefits.

Managed Care Organization (MCO). See Managed Care Plan.

Managed Care Plan. A health plan that has a network of doctors, hospitals, and testing centers, and provisions such as a requirement for pre-authorization prior to specific treatments, tests, or services; includes HMOs and PPOs.

Master Contract. A group health insurance agreement between an employer and an insurer.

MCO. See Managed Care Plan.

Medicaid. A health insurance program sponsored jointly by the federal and state governments, designed to provide insurance for people whose income is below the poverty line and for many children with disabilities.

Medicaid EPSDT Program. A Medicaid program that may provide coverage for certain types of medical problems that are identified during an EPSDT screening of a child with a disability.

Medicaid HMO. An HMO designed specifically for Medicaid recipients.

Medicaid Waiver. An agreement to exempt a state from a particular set of federal Medicaid regulations; a specific waiver may relate to the way in which services are provided or to eligibility for specific services.

Medicare. A health insurance program sponsored by the federal government, designed to provide insurance for senior citizens and for some children and adults with disabilities.

Medicare Allowable Amount. The charge allowed under Medicare rules for a specific service, test, or procedure.

Medicare Beneficiaries Incentive Program. A program designed to encourage Medicare beneficiaries to report possible cases of fraud.

Medicare HMO. An HMO designed specifically for Medicare beneficiaries.

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