Common Terms, Acronyms, and Shorthands

Prior Authorization

A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. A health insurer or plan may require preauthorization for certain services before you receive them, except in an emergency. Prior authorization isn’t a promise that your health insurer or plan will cover the cost.

Program of All-Inclusive Care for the Elderly

A Medicare and/or Medicaid comprehensive medical and social services program available in some states. PACE helps eligible older adults who need nursing home-level care meet their health care needs in the community, by giving them coordinated care and support services (instead of having them go to a nursing home or other care facility).

Presumptive Disability

A severe medical condition that an agency, like the SSA, or a private insurer, presumes to be totally disabling, allowing for faster approval of benefits without extensive proof because the condition is obviously severe or unlikely to improve.

Presumptive Eligibility

The determination of whether an applicant is eligible to enroll in BadgerCare Plus or Family Planning Only Services temporarily. Allows individuals to receive benefits while program application is being completed and processed.

Power of Attorney

A legal document enabling a chosen agent to act on your behalf regarding financial, legal, or medical matters.

Preferred Provider Organization

A type of health insurance plan offered through a private company that provides care through broad provider network, often with a higher deductible or copay. No designated primary care provider. No referrals are required to see specialists. Out of network services are covered at a higher cost.

Psychiatric Residential Treatment Facilities

A component of Medicare providing hospital indemnity insurance.

A component of Medicare providing medical insurance.

A component of Medicare providing MAP.