Glossary
Plain-language definitions of insurance terms.
- COBRA
- A federal law that lets many employees keep their employer health coverage for a limited time after leaving a job, usually by paying the full premium themselves...
- Coinsurance
- The percentage of a covered cost you pay after meeting your deductible — common in health policies (e.g., "insurer pays 80%, you pay 20%").
- Copay
- A fixed dollar amount you pay for a covered service — common in health insurance ("$30 office visit").
- EPO
- An Exclusive Provider Organization covers only in-network providers except in emergencies but, unlike an HMO, usually does not require referrals to see speciali...
- Explanation of Benefits (EOB)
- A statement from your health insurer showing what a provider billed, what the plan paid, and what you may owe. It is not a bill.
- Flexible Spending Account (FSA)
- An employer-offered account that lets you set aside pre-tax dollars for eligible health costs. Funds are generally use-it-or-lose-it within the plan year, with...
- Formulary
- The list of prescription drugs a health plan covers, often organized into tiers that determine your share of the cost.
- Health Reimbursement Arrangement (HRA)
- An employer-funded arrangement that reimburses employees for qualified medical expenses. Only the employer contributes, and the rules vary by the type of HRA.
- Health Savings Account (HSA)
- A tax-advantaged savings account for qualified medical expenses, available only if you are enrolled in a qualified high-deductible health plan. Unused funds rol...
- HMO
- A Health Maintenance Organization is a health plan that generally limits coverage to providers in its network and asks you to choose a primary care physician wh...
- Medicaid
- A joint federal and state program that provides health coverage to eligible low-income individuals and families. Eligibility rules and covered benefits vary by...
- Medicare Advantage
- A Medicare-approved plan offered by private insurers that bundles Part A and Part B coverage, often with extra benefits. Networks and out-of-pocket costs vary b...
- Medigap
- Private insurance, also called Medicare Supplement, that helps pay costs Original Medicare does not cover, such as certain copayments, coinsurance, and deductib...
- Open Enrollment
- Open enrollment is the yearly period when you can sign up for health insurance or change plans. Outside it, you generally need a qualifying life event, such as...
- Out-of-Pocket Maximum
- The most you have to pay for covered services in a plan year. After you reach it, the plan pays 100% of covered in-network costs for the rest of the year.
- POS Plan
- A Point of Service plan blends HMO and PPO features: you pick a primary care doctor and need referrals, but you also get limited out-of-network coverage.
- PPO
- A Preferred Provider Organization is a health plan that lets you see specialists without a referral and covers some out-of-network care, usually at a higher cos...
- Preauthorization
- Approval a health plan may require before it will cover certain services, procedures, or drugs. Skipping it can lead to a denied claim.
- Premium Tax Credit
- A federal subsidy that can lower the monthly premium for a health plan bought through the Marketplace, based on household income and size.
- Provider Network
- The group of doctors, hospitals, and other providers that have contracted with a health plan to deliver care at negotiated rates. Care from in-network providers...
- Short-Term Health Insurance
- Temporary medical coverage meant to fill a gap between other plans. It often excludes pre-existing conditions and may not cover essential benefits, so read the...
- Special Enrollment Period
- A window outside yearly open enrollment when you can sign up for or change health coverage after a qualifying life event, such as marriage, a new baby, or loss...
Health
Health
Health
Health
Health
Health
Health
Health
Health
Health
Health
Health
Health
Health
Health
Health
Health
Health
Health
Health
Health
Health