Bronze Plan

The lowest level of coverage available on the ACA Marketplace, providing the most basic coverage with the lowest premiums but the highest out-of-pocket costs, such as deductibles and copays.

Catastrophic Health Plan

A low-premium, high-deductible health insurance plan available under the ACA Marketplace, primarily covering major medical expenses. Catastrophic plans are available to people under 30 or those with a hardship exemption.

Exchange Plan

A health insurance plan purchased through the ACA Marketplace (also known as the exchange). These plans must meet ACA standards and cover Essential Health Benefits. Exchange plans come in different levels, including Bronze, Silver, Gold, and Platinum.

Gold Plan (ACA)

A health insurance plan offered through the ACA Marketplace that covers approximately 80% of healthcare costs, with the remaining 20% paid by the enrollee. Gold plans have higher premiums but lower out-of-pocket costs compared to Bronze and Silver plans.

Group Health Plan

Health insurance coverage provided to a group of people, typically through an employer or union. Medicare coordinates benefits with group health plans when an individual is eligible for both.

High-Deductible Health Plan (HDHP)

A health insurance plan with a higher deductible and lower premiums. HDHPs are often paired with a Health Savings Account (HSA) to help cover out-of-pocket expenses. These plans are available through the ACA Marketplace and employer-sponsored coverage.

Health Maintenance Organization (HMO)

A type of health insurance plan that provides coverage through a network of doctors, hospitals, and other healthcare providers. Enrollees must typically choose a primary care physician and get referrals to see specialists. ACA, Medicaid, and CHIP offer HMO options.

Job-Based Health Plan

Health insurance coverage provided by an employer to its employees and their dependents. Medicare beneficiaries who have job-based health plans may coordinate benefits between the employer plan and Medicare.

Medicare Advantage (Part C)

A type of health plan offered by private insurance companies that contracts with Medicare to provide all Part A and Part B benefits. Medicare Advantage plans often include extra benefits, such as vision, dental, and prescription drug coverage.

Medicare Supplement Insurance (Medigap)

Private health insurance that helps cover the out-of-pocket costs associated with Original Medicare (Parts A and B), such as copayments, coinsurance, and deductibles. Medigap plans are standardized and regulated by federal and state laws.

Network

A group of doctors, hospitals, and other healthcare providers that have agreed to provide care to members of a health insurance plan at negotiated rates. In Medicare Advantage, Medicaid, and ACA plans, enrollees typically pay less for using in-network providers.

Part C (Medicare Advantage)

A Medicare-approved plan offered by private insurance companies that includes all the benefits of Medicare Part A and Part B, often with additional benefits like dental, vision, and prescription drug coverage.

Qualified Health Plan (QHP)

A health insurance plan that meets the standards set by the ACA and is certified by the Health Insurance Marketplace. QHPs provide Essential Health Benefits and follow established limits on cost-sharing.

Silver Plan (ACA)

A mid-level health plan available through the ACA Marketplace that covers approximately 70% of healthcare costs, with the enrollee paying the remaining 30%. Cost-sharing reductions are only available for those who select a Silver plan and meet income requirements.

Special Needs Plan (SNP)

A type of Medicare Advantage (Part C) plan designed for people with specific diseases or characteristics. SNPs tailor their benefits, provider choices, and drug formularies to meet the unique needs of the groups they serve, such as individuals with chronic conditions or those eligible for both Medicare and Medicaid.

Zero-Cost Sharing Plans

Health insurance plans available under the ACA for certain low-income individuals who qualify for cost-sharing reductions. These plans eliminate out-of-pocket costs like copayments, deductibles, and coinsurance for eligible enrollees, ensuring affordable access to medical services.