An Explanation of Benefits (sometimes called a Claims Summary), is a document the health insurance company sends you and your medical providers telling you how your medical claims (expenses) have been processed. For you it is simply an FYI. The EOB lists the treatments that took place, the portion of the cost that is covered (called the negotiated rate), and the amount remaining for you to pay directly to the doctor. From the EOB (or Claims Summary), the doctor (or

With a PPO, you can see any doctor you like, or visit any hospital usually within a preferred network of providers.  You always have the option of seeing doctors or visiting hospitals that are “out-of-network,” but you will spend more of your own money on medical expenses.   In a PPO, you do not have to choose a Primary Care Physician, and you can usually see any specialist without a referral (although a recommendation is always nice!).   The PPO offers choice,

A Health Maintenance Organization (it used to be called Managed Care, but The Insurance Mom now refers to it as Mangled Care!).  An HMO requires that you see only doctors or hospitals on their list of providers, and sometimes at a specific facility. An HMO also requires that you choose a Primary Care Physician (often sight unseen), who will provide all of your medical care and refer you to an approved specialist if they think it’s necessary. Generally an HMO will not cover medical expenses incurred

State licensed institutional setting which provides nursing and rehabilitative care provided by or under the direction of skilled medical personnel – available 24-hours a day & ordered by a physician under a treatment plan.

In Long Term Care insurance, nursing home or home care that temporarily replaces the existing level of support received from an informal, non paid caregiver for the purpose of providing care and supervision to the patient while relieving the caregiver

Private insurance policies that supplement Medicare benefits by covering co-payments and deductibles for medical and hospital expenses. These policies do not provide coverage for personal or custodial care.

A federal government insurance program to assist those age 65 and over and the disabled with medical and hospital expenses. In addition to hospital and doctor expenses, Medicare covers only skilled care in a skilled nursing facility and limited skilled nursing care at home. It does not provide benefits for personal or custodial care. Medicare requires co-payments and deductibles.

Refers to a wide range of services, from skilled care and physical therapy to personal care delivered at home or in a residential setting

In Long Term Care insurance, services that can be given safely and reasonably by a non-medical person, designed mainly to assist with ADLs, including bathing, eating, dressing and other routine activities

Care for an illness continuing over a long period of time or recurring frequently