Case Management: A process that focuses on coordinating the variety of medical and social services needed by a client.

Coinsurance: The amount the beneficiary pays, usually expressed as a percentage, to share the cost of benefits with the insurer. Once the deductible is met, the beneficiary pays a 20 or 50 percent coinsurance, depending on the type of service.

Copayment: The amount a beneficiary pays each time a service is rendered.

Cost Contract: This type of plan offers more flexibility by allowing Medicare reimbursement for the use of medical services outside the plan's network, subject to the usual coinsurance, deductibles and extra charges you would pay under regular Medicare coverage. As of now, however, this Medicare managed care plan is not offered in Pennsylvania.

Deductible: The amount a beneficiary pays out-of-pocket before insurance benefits are paid.

Discharge Planning: A coordinated program developed by hospitals to ensure that each patient has a plan in place at discharge for needed continuing or follow-up care.

Disenrollment: Cancellation of an individual's enrollment in a health plan.

Fee-for-Service: Traditional method of paying providers for health care expenses after services are performed.

Gatekeeper: A primary care provider who monitors a patient's care and decides if tests, specialists or hospitalization are needed.

HCFA: The federal Health Care Financing Administration responsible for regulating and administering Medicare programs and managed care organizations like HMOs.

Health Maintenance Organization (HMO): A type of managed care plan where access to care is controlled by a primary care doctor and coverage is limited to the approved medical services administered by a network of doctors, hospitals, skilled nursing facilities and other providers included in the plan.

Lock-In: A provision of certain managed care plans, a lock-in requires a beneficiary to receive all covered services through the HMO plan using its own network of providers.

Medically Necessary: Appropriate medical treatment given in accordance with generally accepted standards of medical practice.

Medicare SELECT: A Medigap insurance product which incorporates some features of managed care, paying full supplemental benefits only if covered services are obtained through designated preferred providers.

Point-of-Service Program (POS): An open-ended option offered by an HMO in which enrollees may obtain services outside the plan's network of providers, but at a higher cost.

Precertification: Advance approval required for admission to a hospital or for a surgical procedure.

Preferred Provider Organization (PPO): A health care delivery system in which an insurer or employer negotiates price discounts with certain providers.

Primary Care Physician: A doctor or other designated health care professional who provides regular basic care, usually a family or general practitioner, pediatrician, internist or obstetrician/gynecologist.

Provider: Individual (doctor, nurse, therapist, etc.) or institution (hospital, nursing facility, etc.) providing medical care.

Risk Contract: This type of managed care plan receives a set fee from the sponsoring group (such as an insurer or employer) in exchange for providing all covered care. Once enrolled, the beneficiary is "locked-in" to using the plan's network of providers in order to have the plan cover costs of care.

Service Area: The geographical area defined by a managed care plan within which it will provide health care services to its beneficiaries.