Never Get Lost in the Jargon Again
Every term below is written the way we'd explain it across the kitchen table.
Every term below is written the way we'd explain it across the kitchen table.
The fixed amount you pay every month to keep your coverage active — whether or not you use care.
What you pay out of pocket for covered care before your plan starts sharing the cost.
A flat fee you pay for a specific service, like $30 for a doctor visit.
Your percentage share of a covered cost after you’ve met your deductible — for example, 20%.
The most you’ll pay in a year for covered care. After you hit it, the plan pays 100%.
A subsidy that can lower your monthly Marketplace premium based on income and household size.
Extra savings on Silver Marketplace plans that lower your deductible, copays and out-of-pocket max if your income qualifies.
A Health Maintenance Organization plan that uses a local network and usually requires a primary care doctor and referrals to specialists.
A Preferred Provider Organization plan that lets you see any provider without referrals and offers some out-of-network coverage, usually at a higher premium.
An Exclusive Provider Organization plan with no referral requirement that covers only in-network care except in emergencies.
A plan with lower premiums and a higher deductible that can be paired with a tax-advantaged Health Savings Account.
A tax-advantaged account you can use to pay medical costs, available only with an HSA-eligible high-deductible plan.
The government-run exchange where individuals and families shop for ACA-compliant plans and apply for income-based subsidies.
Marketplace plans are grouped Bronze, Silver, Gold and Platinum by how they split costs — Bronze has lower premiums and higher out-of-pocket costs, Platinum the reverse.
Ten categories of care every ACA plan must cover, including hospitalization, prescriptions, maternity, mental health and preventive services.
The yearly window when anyone can enroll in or change a Marketplace plan without needing a qualifying life event.
A window outside Open Enrollment when you can enroll after a qualifying life event such as losing coverage, marriage, a move or a new baby.
A change — like losing job-based coverage, having a child or moving — that opens a Special Enrollment Period.
Hospital insurance covering inpatient stays, skilled nursing, hospice and some home health care. Most people pay no premium for Part A.
Medical insurance covering doctor visits, outpatient care, preventive services and durable medical equipment, for a monthly premium.
An all-in-one alternative to Original Medicare from private insurers that bundles Part A and B and often Part D, frequently with extra benefits.
Prescription drug coverage sold by private insurers, either standalone or built into a Medicare Advantage plan.
A private policy that pays some of the out-of-pocket costs Original Medicare leaves behind, such as deductibles and coinsurance.
The 7-month window around your 65th birthday — three months before, your birthday month, and three months after — when you first sign up for Medicare.
October 15 to December 7 each year, when you can join, switch or drop Medicare Advantage and Part D plans for the next year.
A right to buy certain Medigap policies without medical underwriting, so you can’t be denied or charged more for health reasons.
A 1-to-5 quality score Medicare assigns to Advantage and Part D plans based on care, service and member experience.
Temporary, lower-cost coverage that bridges a gap between plans. It is not ACA-compliant and may exclude pre-existing conditions.
A plan that pays a set cash amount for covered events regardless of the actual bill. It is a supplement, not major medical coverage.
An Individual Coverage Health Reimbursement Arrangement lets employers give workers a tax-free allowance to buy their own individual plans.
A cafeteria plan that lets employees pay certain premiums with pre-tax dollars, lowering payroll taxes for the worker and the employer.
The doctors, hospitals and pharmacies your plan has contracted with for the best rates. In-network care costs you less.
A plan’s list of covered prescription drugs, usually grouped into cost tiers.
Approval a plan requires before it will cover certain drugs, tests or procedures considered non-emergency.
A statement from your insurer — not a bill — showing what was billed, what the plan paid, and what you may owe.