Health Insurance Marketplace® - Glossary (2024)

FAQs

What are some common health insurance terms and their definitions? ›

A claim is a request for payment for services and benefits you received. Coinsurance. The share of health care services paid by an enrollee. Coinsurance is generally found in conjunction with a deductible. Once the deductible is met, the enrollee is typically responsible for a specified percentage of the medical bill.

The federal Health Insurance Marketplace, which is also called the "Marketplace" or "Exchange," is the website where individuals can browse various health care plans available under the Affordable Care Act, commonly known as "Obamacare," as well as compare them, and purchase health insurance.

Through the Marketplace, individuals and families can shop for coverage if they need to buy health insurance on their own. Premium and cost sharing subsidies based on income are available through the Marketplace to make coverage affordable for individuals and families.

HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.

The income range is $30,000 to $120,000 in 2024 for a family of four. (Income limits may be higher in Alaska and Hawaii because the federal poverty level is higher in those states.) The American Rescue Plan Act of 2021 also extended subsidy eligibility to some people earning more than 400% of the federal poverty level.

The ACA has been highly controversial, despite the positive outcomes. Conservatives objected to the tax increases and higher insurance premiums needed to pay for Obamacare. Some people in the healthcare industry are critical of the additional workload and costs placed on medical providers.

How much does the average person pay for Obamacare? Obamacare costs an average of $584 per month for a 40-year-old with a Silver plan. Your age affects your monthly rates. A 20-year-old pays an average of $443 per month for a Silver plan, while a 60-year-old pays an average of $1,240 per month, before subsidies.

If you buy insurance through your state's health insurance marketplace, you may be able to get financial assistance to help pay your monthly premiums for health insurance. The marketplace will pay your health insurance company for part of the premium, and you will pay the rest.

What is an advantage of purchasing a plan through the health insurance marketplace? ›

Under the Affordable Care Act (ACA), you have special patient protection when you are insured through the Health Insurance Marketplace: Insurers cannot refuse coverage based on gender or a pre-existing condition. There are no lifetime or annual limits on coverage for essential health benefits.

A service that helps people shop for and enroll in health insurance. The federal government operates the Health Insurance Marketplace ^®, available at HealthCare.gov, for most states. Some states run their own Marketplaces.

Levels of plans in the Health Insurance Marketplace ^®: Bronze, Silver, Gold, and Platinum. Categories (sometimes called “metal levels”) are based on how you and your insurance plan split costs. Categories have nothing to do with quality of care. (“Catastrophic” plans are available to some people.)

The four main plans are strategic, tactical, operational, and contingency. The four main plans of business are strategic, tactical, operational and contingency. Strategic planning looks at the long-term issues of the organization, and helps develop a plan for growth or change of business function.

Key takeaways. Low deductibles are best when an illness or injury requires extensive medical care. High-deductible plans offer more manageable premiums and access to HSAs.

The most common, level term insurance, is characterized by level policy face amounts over the contract term period, usually 10, 20, or 30 years. The death benefit amount and policy amounts are usually guaranteed to remain level during this time, regardless of the insured's health status.

Think about a plan's deductible and copays, not just the premium. The amount you pay for your health insurance every month. In addition to your premium, you usually have to pay other costs for your health care, including a deductible, copayments, and coinsurance.

An insurer is the company or organization that provides insurance policies to the insured. This is another word for an insurance company, like the term "carrier." 29. Liability. This refers to a legal obligation or responsibility one party has for causing damage, injury, or loss to another party.