At a glance
- The National Health Interview Survey (NHIS) is used to collect data about health insurance, including type of coverage, who has coverage, and expenses.
- This glossary defines insurance-related terms used in the NHIS questionnaire.
Children's Health Insurance Program (CHIP)
This program was created in 1997. It is designed for uninsured children under age 19—
- With family incomes below 200% of the federal poverty level
- Not currently eligible for Medicaid or covered by private insurance
In some states, CHIP covers pregnant women. States can expand coverage to uninsured low-income children through—
- A separate state program
- Broadening Medicaid eligibility
- Both of the above
Every state and the District of Columbia have a CHIP. The coverage varies from state to state but CHIPs always offer a minimum standard of benefits.
Health Insurance Marketplace
The Health Insurance Marketplace and state-based exchanges were established after the Affordable Care Act was passed in 2010. The federally run exchange is called the Health Insurance Marketplace. States with their own exchanges have specific names such as Connect for Health Colorado and Covered California.
The Marketplace is a resource for individuals, families, and small businesses to—
- Learn about health coverage options
- Compare plans based on costs, benefits, and other features
- Choose a plan
- Enroll in coverage
The Marketplace also provides information about programs that help people with low to moderate incomes and resources pay for coverage. This includes ways to save on monthly premiums and out-of-pocket costs of coverage available through the Marketplace. It also includes information about other programs such as Medicaid and CHIP. In some states, the state runs the Marketplace. In others, the federal government runs it.
A health insurance company that provides exchange coverage in a particular state
The exact name of a health plan in the exchange such as AmBetter Balanced Care 1
The name of a state exchange such as iConnect for Health Colorado or Covered California, healthcare.gov, and Obamacare
Indian Health Service
Members of federally recognized Indian tribes and their descendants are eligible for services provided by the Indian Health Service (IHS). IHS operates a comprehensive health service delivery system for around 75% of the nation's American Indians and Alaska Natives. IHS services are provided directly and through tribally contracted and operated health programs.
Medicaid
Medicaid, established in 1965, is a joint federal and state program. It is designed to help people with limited income and resources cover their medical costs. Although the federal government establishes certain parameters for all states to follow, each state administers its Medicaid program differently, resulting in variations in Medicaid coverage across the country.
Medicare
Medicare, established in 1965, is a federal health insurance program. Almost everyone in the United States aged 65 and older is insured under Medicare. The Centers for Medicare and Medicaid Services (CMS) administers Medicare, the nation's largest health insurance program. Medicare provides insurance to people who are—
- 65 years old and older
- Disabled
- Have permanent kidney failure
Medicare has four parts.
Provides coverage for inpatient hospital services, skilled nursing facilities, some home health services, and hospice care
Helps cover the cost of doctors and other healthcare providers, outpatient hospital services, medical equipment, supplies, and other health services
The Balanced Budget Act of 1997 created Medicare + Choice, Medicare Part C. It expands the range of private health plans that may contract with Medicare on behalf of Medicare beneficiaries. Part C is known as Medicare Advantage. It is an alternative to Parts A and B that bundles several coverage types. Many Medicare Advantage plans also include Part D Coverage. Medicare Advantage is intended to increase beneficiary participation in Health Maintenance Organizations (HMOs) and other private plans. Medicare Advantage options are—
- HMOs
- HMOs with a Point of Service Option
- Preferred Provider Organizations
- Provider-Sponsored Organizations Private Fee-for-Service
Medicare Part D helps to cover prescription drug costs to everyone with Medicare.
Military
Since 1884, health care has been extended to families of military officers and soldiers. In 1943, Congress authorized the Emergency Maternal and Infant Care Program. This program was administered by the "Children's Bureau," through state health departments. In 1956, the Dependents Medical Care Act was signed into law. Amendments to this act in 1966 created Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) in 1967. Today, several types of health care coverage are related to present or former military service members.
The Department of Defense introduced TRICARE to both maintain medical combat readiness and provide health care for all eligible personnel. TRICARE is a regionally managed healthcare program for active duty and retired members of the uniformed services. TRICARE also covers survivors and other family members. TRICARE offers eligible beneficiaries many choices for their health care.
TRICARE for Life (TFL) is a Medicare wrap-around coverage available to Medicare-entitled uniformed service retirees, including—
- Retired guard members and reservists
- Medicare-entitled family members
- Widows/widowers (excludes dependent parents and parents-in-law)
- Medicare-entitled Congressional Medal of honor recipients and their family members
- Certain Medicare-entitled un-remarried former spouses
To participate, the TRICARE enrollee must be—
- Entitled to Medicare Part A (either on the basis of age, disability, or end-stage kidney disease) and
- Enrolled in Medicare Part B
Medicare-eligible beneficiaries who are family members of an active-duty service member (ADSM) are NOT required to purchase Part B. However, when the ADSM retires, Medicare-eligible beneficiaries must purchase Medicare Part B in order to remain TRICARE-eligible.
The VA provides a broad spectrum of medical, surgical, and rehabilitative care to persons who are eligible to receive VA services. To be eligible for VA health care, a person must have—
- Received an honorable discharge from active military service
- Served a minimum of two years (if enlisted after September 7, 1980)
- If a National Guardsman or Reservist served the entire period for which called to active duty (other than for training purposes)
The VA emphasizes prevention/primary care. People are assigned to a priority group depending on whether the veteran has a service-connected disability.
CHAMPVA
CHAMPVA is a healthcare benefits program for dependents (or survivors) of veterans. It is contingent on the veteran being rated by the VA as having a total and permanent disability. CHAMPVA provides benefits to survivors of veterans who died from a VA-rated, service-connected disability. It also offers benefits to survivors of a person who died in the line of duty. In general, CHAMPVA covers most health care services and supplies that are medically and psychologically necessary.
Other state and local programs
These programs vary from state to state. One example of these programs is the Ryan White Act of 1990, which established funding to provide care and services to those with HIV and AIDS.
Private health insurance
Private health insurance are plans marketed by the private health insurance industry. They are not government-run insurance programs. They include policies that cover the costs of doctors and hospitals and those that meet specific needs such as long-term care. Private health insurance policies can be comprehensive or major medical, which provide a broad range of services. Private health insurance also includes plans available through the Federal Health Insurance Marketplace and state-based exchanges.
Single service plans
Single service plans are health insurance that provide only one type of service. Examples include dental care, vision care, prescriptions, nursing home care, hospice care, accidents, catastrophic care, cancer treatment, and/or hospitalization. NHIS currently asks about single service dental, vision, and prescription single service plans.