Glossary
Tags
- ACA
- ACA Marketplace
- ACA subsidies
- CHIP
- CMS
- ESRD
- Extra Help
- FMAP
- FPL
- FQHC
- FSA
- HCBS
- HMO
- HRA
- HSA
- IEP
- IRMAA
- Joint Commision
- KFF
- LCD
- LIS
- Marketplace
- Medicaid
- Medicaid (rare)
- Medicaid expansion
- Medicare
- Medicare Advantage
- Medicare Part A
- Medicare Part B
- Medicare Part D
- Medicare coordination
- Medigap
- NCD
- NEMT
- NOMNC
- Original Medicare
- PCP
- Part A
- Part B
- Part C
- Part D
- QLE
- QMB
- SEP
- SNF
- SNP
- SSI
- Section 1115
- Silver Plan
- Silver plan
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.
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.
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.
Cost-sharing Reduction (CSR)
A subsidy available through the ACA Marketplace that lowers out-of-pocket costs like deductibles, copays, and coinsurance for eligible individuals. CSR is available to people who enroll in Silver-tier plans and meet specific income requirements.
A subsidy available through the ACA Marketplace that lowers out-of-pocket costs like deductibles, copays, and coinsurance for eligible individuals. CSR is available to people who enroll in Silver-tier plans and meet specific income requirements.
Dependent Coverage
Health insurance that covers not only the policyholder but also their dependents, typically children or a spouse. Under the ACA, dependents can stay on their parents’ health insurance plan until age 26.
Health insurance that covers not only the policyholder but also their dependents, typically children or a spouse. Under the ACA, dependents can stay on their parents’ health insurance plan until age 26.
Eligibility
The criteria that individuals must meet to qualify for healthcare programs such as Medicare, Medicaid, CHIP, or ACA Marketplace plans. Eligibility is typically based on factors such as age, income, residency, and health status.
The criteria that individuals must meet to qualify for healthcare programs such as Medicare, Medicaid, CHIP, or ACA Marketplace plans. Eligibility is typically based on factors such as age, income, residency, and health status.
Essential Health Benefits (EHBs)
A set of 10 categories of healthcare services that all ACA-compliant health plans must cover. These services include emergency care, hospitalization, maternity and newborn care, prescription drugs, mental health services, and more.
A set of 10 categories of healthcare services that all ACA-compliant health plans must cover. These services include emergency care, hospitalization, maternity and newborn care, prescription drugs, mental health services, and more.
Exchange (Health Insurance Marketplace)
Also known as the Health Insurance Marketplace, the exchange is an online platform where individuals can compare and purchase ACA-compliant health insurance plans. The Marketplace also provides information on subsidies and tax credits for eligible individuals.
Also known as the Health Insurance Marketplace, the exchange is an online platform where individuals can compare and purchase ACA-compliant health insurance plans. The Marketplace also provides information on subsidies and tax credits for eligible individuals.
Emergency Services
Immediate medical care provided for acute, life-threatening conditions. Medicare, Medicaid, CHIP, and ACA-compliant plans all cover emergency services, often without requiring prior authorization.
Immediate medical care provided for acute, life-threatening conditions. Medicare, Medicaid, CHIP, and ACA-compliant plans all cover emergency services, often without requiring prior authorization.
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.
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.
Enrollment Period
The designated time frame during which individuals can sign up for or make changes to their health insurance coverage. Medicare has an Annual Enrollment Period, and the ACA Marketplace has an Open Enrollment Period.
The designated time frame during which individuals can sign up for or make changes to their health insurance coverage. Medicare has an Annual Enrollment Period, and the ACA Marketplace has an Open Enrollment Period.
Federal Poverty Level (FPL)
A measure of income issued annually by the Department of Health and Human Services (HHS) to determine eligibility for various government assistance programs, including Medicaid, CHIP, and ACA subsidies. The FPL varies based on household size and geographic location.
A measure of income issued annually by the Department of Health and Human Services (HHS) to determine eligibility for various government assistance programs, including Medicaid, CHIP, and ACA subsidies. The FPL varies based on household size and geographic location.
Financial Assistance (ACA)
Subsidies provided through the ACA Marketplace to help eligible individuals and families pay for health insurance premiums and out-of-pocket costs. There are two main types of financial assistance: premium tax credits and cost-sharing reductions.
Subsidies provided through the ACA Marketplace to help eligible individuals and families pay for health insurance premiums and out-of-pocket costs. There are two main types of financial assistance: premium tax credits and cost-sharing reductions.
Family Coverage
A health insurance plan that covers an entire family, including the policyholder, spouse, and dependents. Under the ACA, parents can keep their children on their health plan until age 26, even if the children are not financially dependent or living with the parents.
A health insurance plan that covers an entire family, including the policyholder, spouse, and dependents. Under the ACA, parents can keep their children on their health plan until age 26, even if the children are not financially dependent or living with the parents.
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.
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.
Grace Period
The extra time given to policyholders to pay their health insurance premiums after the due date. During the grace period, coverage continues, but failure to pay by the end of the grace period may result in termination of coverage. This applies to ACA, Medicare, and Medicaid plans.
The extra time given to policyholders to pay their health insurance premiums after the due date. During the grace period, coverage continues, but failure to pay by the end of the grace period may result in termination of coverage. This applies to ACA, Medicare, and Medicaid plans.
Guaranteed Issue
A requirement under the ACA that insurance companies must offer health insurance to any applicant regardless of health status, age, or gender, and cannot deny coverage based on pre-existing conditions.
A requirement under the ACA that insurance companies must offer health insurance to any applicant regardless of health status, age, or gender, and cannot deny coverage based on pre-existing conditions.
Guaranteed Renewal
A feature of health insurance plans that requires the insurer to renew the policyholder’s coverage at the end of each term, regardless of changes in health status. This is required for ACA-compliant plans and Medicare Supplement (Medigap) plans.
A feature of health insurance plans that requires the insurer to renew the policyholder’s coverage at the end of each term, regardless of changes in health status. This is required for ACA-compliant plans and Medicare Supplement (Medigap) plans.
Health Insurance Marketplace
An online platform established by the ACA where individuals and small businesses can compare and purchase health insurance plans. It also provides information on eligibility for subsidies and cost-sharing reductions.
An online platform established by the ACA where individuals and small businesses can compare and purchase health insurance plans. It also provides information on eligibility for subsidies and cost-sharing reductions.
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.
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.