Healthcare itself can be confusing, and the terminology used with healthcare can make matters even worse. Here are some words you should know.
Affordable Care Act: The comprehensive health care reform law enacted in March 2010. Also known as the ACA and Obamacare.
Application assistance: There will be people available in every state to help consumers understand their health coverage options and how to sign up for a plan through the Health Insurance Marketplace. These helpers will have many different names, but the important thing is that they are there to help you. They may be called Navigators, In-Person Assisters (IPA), Certified Application Counselors (CAC), or something else. No matter what they are called, they are there to provide unbiased assistance.
Catastrophic coverage: A health care plan that covers limited services, such as hospitalizations and emergency care. Catastrophic health plans are not comprehensive coverage; they generally require you to pay all of your medical costs up to a certain amount, usually several thousand dollars. These plans will be available to Americans under the age of 30 and to those with limited incomes.
Certified Application Counselors (CAC): There will be people and organizations in each state that can help you better understand and apply for the new options for health coverage. These people will be able to help you apply for and sign up for a plan that fits your needs and your budget. They do not sell insurance or get paid commissions. They provide unbiased information about the coverage options available through the Health Insurance Marketplace. [Also see: Navigators, In-Person Assisters (IPA)]
Children’s Health Insurance Program (CHIP): An insurance program that provides free or low-cost health coverage to children from low-income families. The program is partially funded by both federal and state governments. In some states, pregnant women in families who earn too much to qualify for Medicaid, but can’t afford to purchase private health insurance coverage, are also allowed to enroll in CHIP.
COBRA: This is a federal law that allows some people who have employer-based health coverage to temporarily keep health coverage for themselves and their families after their job is terminated, from between 18 and 36 months after the job is terminated. Individuals and families with COBRA coverage generally have to pay for their entire premium, which for some, can be costly.
Comprehensive Coverage: The health insurance plans offered through the Health Insurance Marketplace must include a basic set of benefits, including doctor visits, hospitalizations, maternity care, emergency room care, prescriptions and more.
Coverage: Also called “health coverage.” This refers to whether someone has health insurance. Different health insurance plans offer different types of coverage. For example, some health insurance plans offer dental and vision coverage, while others do not.
Co-Pay: A fixed amount of money (for example, $15) that you may need to pay for a covered health care service, usually at the time of service. The amount can vary depending on your health insurance plan and the type of health care service—for example, doctor visits or emergency care.
Deductible: The amount of money that you may need to pay out-of-pocket before your health insurance plan begins to pay for health care services. For example, if your deductible is $50, your plan won’t pay for anything until you’ve paid the $50 deductible. Deductibles vary by health insurance plan and may not apply to every service.
Financial Assistance: There may be ways for those with low or middle incomes to get help paying for their health insurance by signing up for a plan through the Health Insurance Marketplace. If you qualify for financial assistance, the government will pay a portion of your health insurance premiums directly to your health insurance company every month. This will lower the amount of money you have to pay for your health insurance premium every month.
Health Insurance: Health insurance is a way to help you pay for your healthcare. It is a contract with an insurer that says they will help pay for your doctor’s visits if you get sick or injured. Having quality health insurance is coverage that helps you stay healthy, protects your wallet, and gives you peace of mind.
Health Insurance Marketplace (Exchange): The Health Insurance Marketplace (sometimes called an Exchange) is a new way to compare and purchase health insurance plans. Every state will have a Health Insurance Marketplace, though each state’s Marketplace will look different. But the important thing is that all plans available through the Marketplace will cover the care you need. You will be able to choose from a selection of insurers and plans in easy-to-understand language, so you can compare the different types of coverage that are available to you.
Health Insurance Requirement: As part of the new healthcare law, most Americans will be required to have health insurance. If you do not have health insurance, you may pay a penalty. You won’t have to pay a penalty if you have a very low income and coverage is unaffordable for you, or for other reasons including your religious beliefs. You can also apply for a waiver asking not to pay a penalty if you aren’t automatically exempt.
In-Person Assisters (IPAs): There will be people and organizations in each state that can help you better understand and apply for the new options for health coverage through the Health Insurance Marketplace. These people will be able to help you apply for and enroll in coverage that fits your needs and your budget. They do not sell insurance or get paid commissions. They provide unbiased information about the coverage options available through the Health Insurance Marketplace. [Also see: Navigators, Certified Application Counselors (CAC)]
Medicaid: A state-administered health insurance program for low-income families and children, pregnant women, people with disabilities, and in some states, other adults. New York State opted into the federal government’s expanded Medicaid, while most other states did not.
Medicare: A federal health insurance program for people who are age 65 or older and certain younger people with disabilities.
Navigators: There will be people and organizations in each state that can help you better understand and apply for the new options for health coverage. These people will be able to help you apply for and enroll in coverage that fits your needs and your budget. They do not sell insurance or get paid commissions. They provide unbiased information about the coverage options available through the Health Insurance Marketplace. [Also see: Certified Application Counselors (CAC), In-Person Assisters (IPA)]
Open Enrollment Period: The period of time when you can sign up for health coverage through the Health Insurance Marketplace. The first open enrollment period runs from October 1, 2013 through March 31, 2014, with coverage beginning as early as January 1, 2014. But you need to sign up by December 15, 2013 for coverage in calendar year 2014. The next open enrollment period will be much shorter, running from October 15, 2014 through December 7, 2014.
Pre-existing Conditions: A current or past medical condition, illness or disability that—before the health reform law was passed—could cause a person to be denied or charged more for their health coverage. Beginning in 2014, people can no longer by denied or charged more for their health coverage because of pre-existing conditions.
Premium: The amount of money that you will pay for your health insurance plan. These payments are usually made monthly, quarterly or yearly.
Preventive Services: Medical services and tests that keep you healthy before you may become sick. These include routine check-ups, patient counseling, screening tests and immunizations.
Qualifying Life Event: A change in your life that can make you eligible for a Special Enrollment Period to enroll in a health insurance plan. Examples of qualifying life events are moving to a new state, certain changes in your income, and changes in your family size (for example, if you marry, divorce or have a baby).
Special Enrollment Period: The first open enrollment period for the new Health Insurance Marketplace is October 1, 2013 to March 31, 2014. Outside of this window, someone may qualify for a special enrollment period. This period lasts until 60 days after a qualifying life event, such as a job loss, birth or divorce.