Affordable Care Act
Also known as ACA, PPACA, or Obamacare, the Affordable Care Act is the comprehensive healthcare reform law enacted in March 2010. While the Affordable Care Act has many proponents and opponents, importantly, it enacted basic patient protections to help young people and those with pre-existing conditions access insurance coverage.
A request to a health insurance company to review a decision denying a benefit, service, or payment.
Catastrophic Health Plan
Catastrophic Health plans have low monthly payments but a high deductible. These plans meet the requirements applicable to other Qualified Health Plans (QHPs, see definition below); however, monthly premiums for catastrophic health plans are typically lower than other QHPs while the out-of-pocket costs are higher.
Children's Health Insurance Program (CHIP)
Insurance program for children in families who earn too much to qualify for Medicaid, but not enough to be able to afford private insurance. In some states, CHIP also covers pregnant women.
A request for payment submitted to your insurer for services rendered.
Stands for Consolidated Omnibus Budget Reconciliation Act, COBRA is a federal law that allows individuals to temporarily keep employer-provided health insurance after employment ends or another qualifying event. If someone elects COBRA coverage, they are responsible for 100 percent of the premiums.
Your share of the costs of certain medical care or medications, calculated as a percentage of the total cost. For example, if the health insurance plan's allowed amount for an office visit is $100 and you've met your deductible, your coinsurance payment of 20 percent would be $20. The health plan pays the rest of the cost.
A fixed amount you pay for certain medical care or medications. The amount can vary by the type of health care service.
The share of costs for services covered by your insurance that you pay out-of-pocket. This generally includes deductibles, coinsurance, and copayments. This does not include premiums or non-covered services.
Cost Sharing Reductions
Discounts that lower the amount individuals have to pay for deductibles, copayments, and coinsurance for plans on the individual and small group markets. Individuals who qualify for cost-sharing reductions also have a lower out-of-pocket maximum. The cost sharing reductions are paid to the insurer by the federal government. The Trump Administration decided not to pay the cost sharing reduction payments to insurers in 2018.