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For more comprehensive glossaries related to insurance and health care reform, see healthcare.gov and AARP’s glossaries.
Bronze Plan: In the Health Insurance Marketplace, plans that cover an average of 60 percent of the cost of providing essential health benefits. With a Bronze plan, you will pay an average of 40 percent of the cost of essential health benefit services. This means your monthly premium will be low, but your out-of-pocket costs will be higher when you need health services.
Catastrophic Plan: In the Health Care Marketplace, plans that will not cover any benefits other than 3 primary care visits per year before you pay off your deductible. Premiums for these plans are low, but out-of-pocket costs (deductibles, co-pays, or coinsurance) are high. This type of health plan is only available to people under 30 years of age or who can’t afford health coverage and have been given a hardship exemption.
Co-pay: A set dollar amount (for example, $20) that you pay for a health care service covered by your insurance plan. The dollar amount can vary by the type of health care service received and is usually paid at the time you receive care. Also called co-payment.
Coinsurance: Your share of the cost of a covered health care service, calculated as a percent (for example, 10%). You pay coinsurance plus any deductible you owe. For example, if your plan’s allowed amount for a specialist visit is $100 and you’ve met your deductible, your coinsurance payment of 10% would be $10. Your insurance plan pays the rest ($90) of the allowed dollar amount.
Deductible: A fixed dollar amount that you owe for health care services covered by your plan before your insurance provider will begin to pay for them. For example, if your deductible is $2,500, until you pay this amount for those health care services subject to the deductible, your insurance plan will not pay for covered services.
Fertility Preservation: A type of procedure to help a person keep his or her ability to remain fertile, or have children. The procedure is done before a person receives medical treatment (for example, chemotherapy) that might make him or her infertile. Some examples of fertility preservation procedures are sperm banking and egg freezing.
Gold Plan: In the Health Insurance Marketplace, plans that cover an average of 80 percent of the cost of providing essential health benefits. With a Gold plan, you will pay an average of 20 percent of the cost of essential health benefit services.
Hardship Exemption: Under the Affordable Care Act, most people must pay a fee if they do not have health insurance coverage that counts as “minimum essential coverage.” One exception is if that person proves a “hardship” (for example, a financial issue) that prevents them from becoming insured. In that case, they are not required to pay the fee.
Health Insurance Marketplace/Exchange: A resource that allows individuals, families, and small businesses to learn about their options for health coverage; compare health insurance plans based on costs, benefits, and other important qualities; choose a plan; and enroll in coverage. The Marketplace/Exchange also offers information on programs that can help people with low to moderate income and resources pay for coverage. It is able to be accessed through websites, call centers, or through in-person help from a navigator.
Hospice Care: Care that offers physical, emotional and spiritual support during the transition to the end of a person’s life. Hospice care teams often include your usual health care team plus psychologists, social workers, or spiritual leaders. The team helps ensure the person in hospice care is comfortable and offers caregivers support. Hospice care can be given in the home or in a care facility.
Insurance plans: Health plans in the Marketplace make up 4 categories—Bronze, Silver, Gold, or Platinum—based on the percentage of the average overall cost of providing essential health benefits to members that the plan pays. The plan category you choose affects the total dollar amount you will likely spend for essential health benefits during the year. The percentages the plans will cover, on average, are 60% (Bronze), 70% (Silver), 80% (Gold), and 90% (Platinum). Catastrophic plans will also be available to some consumers.
Navigator: A person or organization available to help you use the Health Insurance Marketplace/Exchange to compare plan options and complete eligibility and enrollment forms. Navigators are unbiased, specially trained, and offer their service for free.
Out-of-pocket: Any fees for medical care that you must pay on your own, without help from your insurance provider. Deductibles, coinsurance, and co-pays are all out-of-pocket expenses. If you need a service that your health insurance plan does not cover, you will pay the total cost of that service out-of-pocket.
Palliative Care: Care given to improve the quality of life of those who have serious or life-limiting illnesses. The goal of palliative care is to prevent or ease symptoms of a disease and the side effects of treatments as early as possible to ensure the psychological, spiritual, and physical comfort of a patient.
Platinum Plan: In the Health Insurance Marketplace, plans that cover an average of 90 percent of the cost of providing essential health benefits. With a Platinum plan, you will pay an average of 10 percent of the cost of essential health benefit services. Though your out-of-pocket costs are low when you receive health services, you will pay a high monthly premium.
Preauthorization: A decision made by your health insurer that a specific healthcare service, treatment, or kind of medical equipment is medically necessary to care for you. Also called prior approval, prior authorization, or precertification.
Premium: The dollar amount that you must pay for your health plan coverage. If you have health insurance through your employer, you and your employer may each pay a part of the premium monthly, quarterly, or yearly.
Preventive Services: Routine health care that includes screenings, check-ups, and patient counseling to prevent illness or other health problems.
Preventive Mastectomy: The removal of one or both breasts by surgery to prevent or reduce the risk of breast cancer forming in those who are at high-risk of getting the disease. Also called prophylactic or risk-reducing mastectomy.
Referral: A written order from your primary care doctor for you to see a medical specialist or get certain medical services. Many insurance plans may require that you get a referral before you can receive medical care from anyone except your primary care doctor. If you do not get a referral first, often the plan will not pay for the health care services you receive.
Respite Care: Temporary care of a sick or disabled person in a care facility or in the home, which is given to relieve the person’s caregiver in the short-term.
Silver Plan: In the Health Insurance Marketplace, plans that cover an average of 70 percent of the cost of providing essential health benefits. With a Silver plan, you will pay an average of 30 percent of the cost of essential health benefit services.
