All Terms Explained

A

ACA

The Affordable Care Act, the law that expanded health coverage and created the individual marketplace.

Accident Insurance

A plan that pays you cash if you’re injured in an accident.

Agent

A licensed professional who helps you pick a plan.

Allowance (ICHRA)

Money your employer gives you each month to buy your own health plan.

Ancillary Benefits

Extras like dental, vision, accident or wellness add-ons.

Annual Limit

The maximum amount a plan will pay for your care in a year.

B

Balance Billing

A bill for the difference between what your plan pays and what an out-of-network provider charges.

Broker

Someone who helps you compare and choose plans. Usually at no extra cost to you.

C

COBRA

Temporary coverage you can get after leaving a job.

Claim

A request for payment that your doctor sends to your insurance.

Coinsurance

The percentage you pay for a service after meeting your deductible.

Copay

A fixed amount you pay for a visit or service (like $20 for a doctor’s appointment).

D

Deductible

The amount you pay out of pocket before your plan starts covering costs.

Dual Coverage

When you’re covered by two insurance plans at the same time.

E

EPO

A type of plan where you must use in-network doctors except in emergencies.

Enrollment Period

The window when you can sign up or change your plan.

Essential Health Benefits

The 10 categories of care every ACA plan

ACA plan

Are health insurance plans that follow federal rules and include essential benefits like doctor visits, prescriptions, and preventive care.

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must cover (like maternity, emergency, prescriptions).

F

FSA

Flexible Spending Account, an account you use to pay for certain medical expenses tax-free.

M

MAGI

Your Modified Adjusted Gross Income, used to calculate subsidy eligibility.

Marketplace

The online place where you shop for ACA health plans.

O

Out-of-pocket Maximum

The most you’ll pay in a year before your plan covers 100% of costs.

P

Premium

The amount you pay each month to keep your plan active.

Provider

Any doctor, hospital, or clinic that delivers care.

S

Short-Term Medical

Temporary coverage for gaps between major health plans

Major Health Plans

Temporary coverage for gaps between major health plans.

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Subsidy

Financial help that lowers your monthly costs if you qualify based on income.