Plain-English definitions of the Medicare, ACA health, and life insurance terms most consumers ask about. Each definition is reviewed by a licensed insurance professional. Cross-linked from across our editorial content so you can read in context.
Healthcare.gov and state exchanges where you buy ACA-compliant individual health insurance.
Federal-state program for children whose families exceed Medicaid income limits but can't afford private coverage.
Federal law allowing 18-36 month continuation of employer health coverage after a qualifying event — at full cost.
Fixed dollar amount you pay for a covered service ($25 for office visit, $10 for generic Rx, etc.).
Silver-plan-only ACA subsidy that lowers deductibles, copays, and out-of-pocket max for households under 250% FPL.
10 categories of services every ACA-compliant plan must cover.
Annual income benchmark used to determine eligibility for ACA subsidies, Medicaid, and other programs.
ACA-compliant plan that meets IRS deductible/OOP-max thresholds and qualifies for HSA contributions.
Health plan with closed network and primary care gatekeeper for specialist referrals.
Triple-tax-advantaged savings account paired with HDHP — for medical expenses now or later.
Employer reimburses employees tax-free for individual ACA marketplace coverage instead of offering a group plan.
Federal-state low-income health coverage — income limits for adults vary by state expansion status.
Income measure used for ACA subsidies, Medicaid eligibility, and Medicare IRMAA.
Annual window to enroll in or change ACA marketplace plans — Nov 1 to Jan 15 federally.
Health plan with broader network and out-of-network coverage at higher cost-sharing.
Federal subsidy that lowers your monthly ACA marketplace premium based on income.
Above-the-line deduction for self-employed health insurance premiums — Form 1040 Schedule 1.
Non-ACA-compliant temporary health coverage — useful as a stopgap, problematic as a permanent solution.
60-day window to enroll in or change ACA marketplace coverage outside Open Enrollment, triggered by a Qualifying Life Event.