Health Insurance Glossary
Advance Premium Tax Credit: an income-based tax credit you can get to lower your monthly health insurance payment
Affordable Care Act (aka “Obamacare”): the law ensuring all Americans the right to access health insurance. Under this law, no one can be turned down for coverage due to preexisting conditions such as diabetes, and all plans must offer essential health services, such as chronic disease management, wellness exams, prescriptions, and prenatal care.
Annual Limit: the maximum amount your insurance company will pay for your coverage in a year. After that, you are responsible for all costs.
Catastrophic Health Plan: a bare-bones type of insurance, designed for young adults who are considered healthy. The monthly premium is cheap, but the deductible is very high. The plan covers only three primary care visits per year until the plan’s deductible is met. All of your other costs, such as medications, will be high.
Children’s Health Insurance Program (CHIP): low-cost health insurance for kids whose parents can’t afford insurance but make too much to qualify for Medicaid
Consolidated Omnibus Budget Reconciliation Act (COBRA): a law that allows you to keep your health coverage after you lose a job. You’ll pay 100 percent of the premium cost—what your employer paid and what you paid monthly—plus an administrative fee.
Co-pay: the set amount you pay for a covered health care service
Cost Sharing Reduction (CSR): sometimes called an “extra savings,” this is a discount that lowers what you pay for deductibles, co-payments, and coinsurance.
Deductible: the annual amount you pay for certain covered health care services before your insurance plan starts to pay
Flexible Spending Account: money you elect to pull from your paycheck pretax, specifically for health costs
Formulary: list of drugs covered by a prescription drug plan or an insurance plan offering prescription drug benefits
Health Savings Account: a savings account that allows users to set aside money, pretax, to pay for qualified medical expenses. You can get one through your employer if you have a high-deductible health plan—any plan with a deductible of at least $1,350 for an individual or $2,700 for a family.
In Network: providers who have contracted into a particular health plan, resulting in lower costs for you
Mandate/Penalty: the requirement that everyone get health insurance coverage or pay a fee on their taxes. The current penalty is $0.
Navigator: a person trained to help people look for health coverage options and sign up for insurance through the marketplace
Out of Network: providers who have not contracted into a particular health plan; it’s likely more expensive to see them.
Premium: the amount you pay for your health insurance coverage each month
Qualifying Life Event: a situation (such as getting married) that allows you to apply for insurance outside of open enrollment
Subsidies: tax credits you can use to lower your monthly insurance payments if you purchase a plan through your state or federal marketplace. Also called premium tax credits.