RESOURCE CENTER: Healthcare Glossary
Find definitions for healthcare related terms.
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A-ACA
See "Affordable Care Act".
A-Affordable Care Act
The Patient Protection and Affordable Care Act (PPACA), also known as "ObamaCare", was signed into law on March 23, 2010. This new law enforced easily accessible, affordable healthcare and stronger consumer protection.
Show moreless »C-COBRA
The Consolidated Omnibus Budget Reconciliation Act (COBRA) plan requires group (employer-provided) health plans to temporarily continue health coverage for employees whose coverage has been discontinued and their eligible dependents for as long as the employee is not covered by other insurance plans.
Show moreless »C-Coinsurance
Your share of the costs of a covered health care service, calculated as a percentage of the allowed amount for the service. You are responsible for paying the coinsurance plus any deductibles owed. Your health insurance or plan pays the rest.
Show moreless »C-Copayment
The fixed amount that you pay for a covered healthcare service, usually at the time of service. The amount varies by the type of covered service.
C-Cost-Sharing
Your out-of-pocket costs that are then covered by your insurance, including deductibles, coinsurance, and co-payments, or similar charges. Does not include premiums, balance billing amounts for non-network providers, or the cost of services not covered by your plan.
Show moreless »C-Coverage Gap
The temporary limit on what your plan will cover for prescription drugs.
D-Deductible
The amount you must pay for applicable covered healthcare services before your health insurance takes over.
D-Dependant
A person who relies on someone for financial support (i.e., your child and/or your spouse).
E-Eligibility
Whether or not you qualify to sign up for an Obamacare plan.
E-EPO
An Exclusive Provider Organization (EPO) plan is a managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency).
Show moreless »E-Essential Benefits (ACA)
The ten essential health services that all health insurance plans must cover.
H-HSA
A Health Savings Account can be opened by those who are covered by high-deductible health plans for tax-preferred treatment of money saved for medical expenses.
H-HMO
A Health Maintenance Organization (HMO) plan is a type of healthcare plan that usually limits coverage to care from doctors, hospitals, and healthcare facilities that work for or contract with the HMO. You may be required to live or work in the HMO service area in order to receive coverage.
Show moreless »I-Individual and Family Health Insurance
Coverage provided to those who are ineligible for a group plan, such as those provided by an employer.
M-Major Medical Insurance
Full comprehensive health insurance that covers the ten essential benefits mandated by the Affordable Care Act and other day to day care as needed.
M-Marketplace
The ACA-supported insurance purchasing interface you can use to find a plan if you don’t have coverage through a job, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or another source.
Show moreless »M-Maximum Out of Pocket Costs
The maximum amount you pay during a policy period before your health coverage will pay 100% for covered essential health benefits. This limit must include deductibles, coinsurance, co-payments, or similar charges as well as any other expenses that qualify the medical expense for the essential health benefits.
Show moreless »M-Medicaid
A government-run program that provides free or low-cost health coverage to low-income individuals, families and children, pregnant women, elderly individuals, and individuals with disabilities.
M-Medicare
A government-run program that provides insurance to those aged 65 and older as well as those with disabilities and/or permanent kidney failure.
N-Network
A group of doctors, hospitals, pharmacists, and other healthcare providers that all participate in a healthcare plan. Care received by these people will be covered by your health insurance plan.
N-Network Provider
A doctor, hospital, pharmacist, or other healthcare provider that participates in a network of providers.
O-Obamacare
See "Affordable Care Act".
O-Office Visit
When you visit your healthcare provider for services, excluding consultations.
O-Open Enrollment
The period of time when individuals can enroll for a qualified health plan. The Open Enrollment Period has been shortened this year and occurs from November 1st - December 15th.
O-Out of Network
Seeking healthcare services from providers outside of the network for you particular plan.
P-PCP
Primary Care Physician
P-POS
A Point of Service (POS) plan is a type of healthcare plan that charges less if you visit medical providers (i.e., physicians and hospitals) that participate in the plan’s network. However, like PPO plans, you do have the option to seek care from out-of-network providers.
Show moreless »P-PPO
A Preferred Provider Organization (PPO) plan is a type of healthcare plan that partners with a network of participating medical providers (i.e., physicians and hospitals).
P-Pre-existing Condition
A medical condition you had prior to your healthcare coverage taking effect.
P-Premium
The monthly charge you must pay based on your health insurance coverage.
P-Prescription Drug Coverage
Healthcare coverage that helps you pay for prescription drugs and medications. The cost sharing varies by plan.
P-Provider
Doctors, hospitals, pharmacists, and other healthcare services.
S-Short Term
Short-term health insurance provides you with temporary health coverage at a time when you’re unable to obtain full health coverage.
S-Special Enrollment Period
A period of 60 days after a qualifying life event (when the Open Enrollment Period is over) when you may apply for a health insurance plan.
S-Subsidy
Financial assistance in the form of tax credits designed to help people with low and middle incomes afford health insurance.
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