Special Needs Plan (SNP)

A type of Medicare Advantage (Part C) plan designed for people with specific diseases or characteristics. SNPs tailor their benefits, provider choices, and drug formularies to meet the unique needs of the groups they serve, such as individuals with chronic conditions or those eligible for both Medicare and Medicaid.

Telehealth

The use of technology, such as video calls or phone consultations, to provide healthcare services remotely. Telehealth is increasingly covered by Medicare, Medicaid, CHIP, and ACA plans, especially for mental health services and routine checkups.

Tax Penalty (ACA)

A financial penalty imposed on individuals who did not have health insurance coverage under the ACA's individual mandate. Although the federal tax penalty was reduced to $0 in 2019, some states still impose penalties for not having qualifying health coverage.

Tiered Drug Formulary

A system used by health insurance plans to categorize prescription drugs into different cost tiers, with generic drugs typically in the lowest tier and specialty or brand-name drugs in higher tiers. Medicare Part D and ACA plans often use a tiered formulary system.

TRICARE

A healthcare program for uniformed service members, retirees, and their families. Medicare coordinates with TRICARE to provide comprehensive coverage for military retirees who are eligible for both programs.

Timely Filing Limit

The period within which a claim for medical services must be submitted to an insurance provider to be eligible for reimbursement. Medicare, Medicaid, and private insurance plans have specific timely filing limits, typically ranging from 90 days to one year.

Transitional Medicaid Assistance (TMA)

A Medicaid program that provides temporary coverage to families who lose Medicaid eligibility due to an increase in income. TMA ensures that individuals can still access healthcare services for a certain period while transitioning to new coverage.

Urgent Care

Medical services provided for conditions that require prompt attention but are not serious enough for emergency room care. Medicare, Medicaid, CHIP, and ACA Marketplace plans often cover urgent care visits, with varying copayments or coinsurance.

Utilization Management

A process used by health insurance providers to evaluate the necessity and efficiency of healthcare services. It includes practices like prior authorization, step therapy, and case reviews to ensure appropriate use of medical resources. Common in Medicare Advantage, Medicaid, and ACA plans.

Uncompensated Care

Medical services provided to patients who are unable to pay and do not have insurance coverage. Medicaid expansion under the ACA has helped reduce the amount of uncompensated care provided by hospitals by covering more low-income individuals.

Urgent Need Care (Medicare)

Immediate medical care required for sudden illnesses or injuries that are not life-threatening but require prompt attention. Medicare Advantage plans typically cover urgent care services, and they may have lower out-of-pocket costs than emergency room visits.

Vaccinations

Immunizations provided to protect against diseases such as the flu, measles, and pneumonia. Medicare, Medicaid, CHIP, and ACA plans cover many vaccinations, often without out-of-pocket costs, especially as part of preventive services.

Value-Based Care

A healthcare delivery model in which providers are reimbursed based on patient health outcomes rather than the number of services delivered. Medicare, Medicaid, and some ACA programs have adopted value-based care models to improve quality and reduce costs.

Vision Coverage

Insurance coverage for eye care services, such as routine eye exams, glasses, and contact lenses. Medicaid and CHIP often include vision benefits for children, while vision coverage for adults is limited under Medicare unless purchased through a Medicare Advantage plan.

Veterans Affairs (VA) Healthcare

A healthcare system operated by the Department of Veterans Affairs (VA) that provides medical services to eligible U.S. veterans. Veterans who qualify for both VA healthcare and Medicare may use both programs to maximize coverage.

Voluntary Disenrollment

The process by which an individual chooses to leave a health insurance plan, such as Medicare Advantage, Medicare Part D, or a Medicaid managed care plan. Beneficiaries may disenroll during the appropriate enrollment periods or under special circumstances.

Wellness Visit

A preventive health check-up aimed at assessing overall health, identifying potential health risks, and offering screenings and counseling. Medicare covers an annual wellness visit, while Medicaid, CHIP, and ACA plans cover various preventive services, including wellness visits.

Waiver (Medicaid)

A provision that allows states to modify certain Medicaid rules to provide specialized healthcare services to targeted populations. Examples include Home and Community-Based Services (HCBS) waivers and Section 1115 waivers, which allow innovative approaches to care for specific groups, such as seniors or people with disabilities.

Waiting Period

The period of time between the date a person applies for health insurance and the date coverage begins. Waiting periods are sometimes imposed in employer-sponsored health plans, but under the ACA, they cannot exceed 90 days. Medicaid and CHIP usually do not have waiting periods for coverage.

Work Requirements (Medicaid)

Policies that require Medicaid recipients to work, volunteer, or participate in job training as a condition of receiving healthcare benefits. Some states have received federal waivers to implement Medicaid work requirements, though these policies have been challenged in courts.