Health Insurance Glossary
Health insurance terms, explained simply
Definitions from HealthCare.gov, paired with practical context so you can pick a plan that actually fits. Use search to find a term, or browse the full list below. Understand deductibles, premiums, copays, HMOs, PPOs, and everything in between.
Showing 24 of 256 health insurance terms
GeneralOut-of-pocket estimate
An estimate of the amount that you may have to pay on your own for health care or prescription drug costs. The estimate is made before your…
GeneralDeductible
How much you’ll pay for certain covered services and items each year before your plan starts to pay (except free preventive services).
GeneralOut-of-network coinsurance
The percentage (for example, 40%) you pay of the allowed amount for covered health care services to providers who don't contract with your…
GeneralUncompensated care
Health care or services provided by hospitals or health care providers that don't get reimbursed. Often uncompensated care arises when…
GeneralAlimony
Alimony is money you get from a spouse with whom you no longer live, or a former spouse, if paid to you as part of a divorce agreement,…
GeneralFee
A payment ("penalty," "fine," "individual mandate") you made when you filed federal taxes if you didn't have health insurance that counted…
GeneralExchange
Another term for the Health Insurance Marketplace®, a service available in every state that helps individuals, families, and small…
GeneralUrgent care
Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe it requires…
GeneralPlan
A benefit your employer, union or other group sponsor provides to you to pay for your health care services.
GeneralFederal poverty level (FPL)
A measure of income updated each year by the Department of Health and Human Services (HHS) that’s used to determine eligibility for certain…
GeneralHealth Maintenance Organization (HMO)
A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't…
GeneralBrand name (drugs)
A drug sold by a drug company under a specific name or trademark and that is protected by a patent. Brand name drugs may be available by…
GeneralCanceled debts
If you incurred a debt from a loan or from buying something on credit and a portion of the amount you owe is discharged or forgiven…
GeneralLong-term care
Services that include medical and non-medical care provided to people who are unable to perform basic activities of daily living such as…
GeneralIn Person Assistance Personnel Program
Individuals or organizations that are trained and able to provide help to consumers, small businesses, and their employees as they look for…
GeneralEmergency medical transportation
Ambulance services for an emergency medical condition.
Employer PlansCafeteria plan
A cafeteria plan is a separate written plan maintained by an employer for employees that meets the specific requirements and regulations of…
ACA / MarketplacePremium tax credit
A tax credit you can use to lower your monthly insurance payment (your “premium”).
GeneralGrace period
A short period after your monthly health insurance payment is due to pay all owed premiums to avoid losing coverage.
GeneralQualifying life event (QLE)
Like getting married, new baby or dependent, moving, or losing health coverage.
GeneralValue-based purchasing (VBP)
Linking provider payments to improved performance by health care providers. This form of payment holds health care providers accountable…
ACA / MarketplaceGrandfathered health plan
An individual health insurance policy purchased on or before March 23, 2010. These plans weren’t sold through the Marketplace, but by…
GeneralNet capital gains
The amount by which your total long-term capital gain for the year is more than your short-term capital loss for the year.
GeneralDonut hole (Medicare prescription drug)
Medicare drug plans previously had a coverage gap (also called the "donut hole"). The donut hole was a temporary limit on what the drug…
Showing 1–24 of 256 results
Common Questions About Health Insurance Terms
Health Insurance Definitions by State
Health insurance rules, marketplace plans, and Medicaid eligibility vary by state. Explore state-specific guides to understand how terms apply where you live.
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