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
ACA Marketplace
An online platform where individuals can shop for, compare, and purchase health insurance plans offered under the ACA. It offers tiered plans (Bronze, Silver, Gold, Platinum) with varying coverage levels and costs.
An online platform where individuals can shop for, compare, and purchase health insurance plans offered under the ACA. It offers tiered plans (Bronze, Silver, Gold, Platinum) with varying coverage levels and costs.
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.
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.
Disenrollment
The process of voluntarily or involuntarily terminating coverage under a health insurance plan, such as Medicare, Medicaid, or CHIP. Disenrollment may occur if a beneficiary no longer meets eligibility requirements or chooses to switch plans.
The process of voluntarily or involuntarily terminating coverage under a health insurance plan, such as Medicare, Medicaid, or CHIP. Disenrollment may occur if a beneficiary no longer meets eligibility requirements or chooses to switch plans.
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.
Exclusions
Services or treatments that are not covered by a health insurance plan. Exclusions vary by plan, and they may include specific treatments, procedures, or prescription drugs that are not considered medically necessary.
Services or treatments that are not covered by a health insurance plan. Exclusions vary by plan, and they may include specific treatments, procedures, or prescription drugs that are not considered medically necessary.
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.
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.
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.
Individual Mandate
A provision of the ACA that required individuals to have health insurance or pay a penalty. While the federal penalty was eliminated in 2019, some states still enforce individual mandates.
A provision of the ACA that required individuals to have health insurance or pay a penalty. While the federal penalty was eliminated in 2019, some states still enforce individual mandates.
Insurance Premium
The amount paid, often monthly, for health insurance coverage. Premiums are required to maintain enrollment in programs like ACA Marketplace plans, Medicare, Medicaid, and private health insurance.
The amount paid, often monthly, for health insurance coverage. Premiums are required to maintain enrollment in programs like ACA Marketplace plans, Medicare, Medicaid, and private health insurance.
Pre-Existing Condition
A health condition that existed before the start of an individual's health insurance coverage. Under the ACA, insurers cannot deny coverage or charge higher premiums based on pre-existing conditions.
A health condition that existed before the start of an individual's health insurance coverage. Under the ACA, insurers cannot deny coverage or charge higher premiums based on pre-existing conditions.
Premium
The monthly amount paid for health insurance coverage. Premiums are required for plans offered under the ACA Marketplace, Medicare, Medicaid (in some states), and CHIP.
The monthly amount paid for health insurance coverage. Premiums are required for plans offered under the ACA Marketplace, Medicare, Medicaid (in some states), and CHIP.
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.
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.
Qualifying Life Event (QLE)
A major life event that allows an individual to enroll in or make changes to their health insurance plan outside of the Open Enrollment Period. Examples of QLEs include marriage, divorce, birth of a child, or loss of other health coverage.
A major life event that allows an individual to enroll in or make changes to their health insurance plan outside of the Open Enrollment Period. Examples of QLEs include marriage, divorce, birth of a child, or loss of other health coverage.