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
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…
GeneralAffordable Care Act (ACA)
The comprehensive health care reform law enacted in March 2010 to make affordable health insurance available to more people, expand…
Employer PlansGroup health plan
In general, a health plan offered by an employer or employee organization that provides health coverage to employees and their families.
GeneralAccreditation
If a Marketplace health plan is approved, this is the “seal of approval” given to the plan by an independent organization to show that the…
GeneralExchange
Another term for the Health Insurance Marketplace®, a service available in every state that helps individuals, families, and small…
GeneralMinimum value
A standard of minimum coverage that applies to job-based health plans. If your employer’s plan meets this standard and is considered…
GeneralComplication of pregnancy
Conditions due to pregnancy, labor and delivery that require medical care to prevent serious harm to the health of the mother or the fetus.…
GeneralGold health plan
One of 4 health plan categories (or “metal levels”) in the Health Insurance Marketplace®. Gold plans usually have higher monthly premiums…
GeneralMedicare prescription drug donut hole
Medicare drug plans previously had a coverage gap (also called the "donut hole"). The donut hole was a temporary limit on what the drug…
GeneralHealth care workforce incentive
The use of incentives and recruiting to encourage people to enter into health care professions like primary care and to encourage providers…
GeneralBiosimilar biological products
The generic version of more complicated medications.
GeneralHigh-cost excise tax
Under the Affordable Care Act starting in 2018, a tax on insurance companies that provide high-cost plans. This tax encourages streamlining…
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…
GeneralDurable medical equipment (DME)
Equipment and supplies ordered by a health care provider for everyday or extended use. Coverage for DME may include: oxygen equipment,…
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…
GeneralGrievance
A complaint that you communicate to your health insurer or plan.
GeneralOut-of-pocket maximum/limit
The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for…
GeneralWell-baby and well-child visits
Routine doctor visits for comprehensive preventive health services that occur when a baby is young and annual visits until a child reaches…
GeneralPrimary care
Health services that cover a range of prevention, wellness, and treatment for common illnesses. Primary care providers include doctors,…
GeneralDental coverage
Benefits that help pay for the cost of visits to a dentist for basic or preventive services, like teeth cleaning, X-rays, and fillings. In…
GeneralLifetime limit
A cap on the total lifetime benefits you may get from your insurance company. An insurance company may impose a total lifetime dollar limit…
GeneralPre-existing condition exclusion period (individual policy)
The time period during which an individual policy won't pay for care relating to a pre-existing condition. Under an individual policy,…
GeneralSilver health plan
One of 4 categories of Health Insurance Marketplace® plans (sometimes called “metal levels”). Silver plans fall about in the middle: You…
GeneralPrescription drugs
Drugs and medications that, by law, require a prescription.
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.
Ready to apply what you've learned?
Now that you understand these health insurance terms, compare real plans available in your area. See actual premiums, networks, and prescription coverage side by side.