Health Care Terms Defined
Brush up on your insurance-related vocabulary with this glossary, which includes definitions for everything from copays to donut hole to employer mandate
Affordable Care Act
A set of health care reforms passed by Congress and signed into law by President Barack Obama in March 2010. The goal of this law, which is more formally called the Patient Protection and Affordable Care Act and more informally nicknamed Obamacare, was to make affordable, quality health care accessible to more Americans. It also aims to give both the insured and uninsured new patient protections to make coverage more fair and easier to understand.
Stands for Consolidated Omnibus Budget Reconciliation Act. It allows workers the right to stay on their employer's health insurance plan for a certain period of time, though they may be required to pay the entire cost of their coverage.
The amount you must pay when you receive medical services, such as a doctor's office visit or a prescription, in addition to what your insurance provider pays. This out-of-pocket amount is predetermined in your insurance policy.
A specific amount of money that you must pay before your health insurance will start paying on a health-care claim you have made. This is an out-of-pocket cost. Typically, if you have an HMO, it does not have a deductible (but the trade-off is you are limited to doctors/care providers within that HMO's "network").
In Medicare Part D, which covers prescription drugs, most plans have a coverage gap, which is often referred to as the "donut hole," where coverage is cut off after spending a certain amount and then starts up again after you've reached a new threshold of cost. The Affordable Care Act eliminates this gap in coverage by 2020.
Insurance plans that are provided by your employer and partially covered by them. This is the type of insurance plan most Americans have.
The requirement that businesses with more than 50 full-time employees must offer health insurance to their employees and their dependents under the age of 26, starting in 2015.
Health care plans that existed on or before March 23, 2010 and have stayed basically the same – with no major changes to benefits or how much you pay. These may not be subject to all of the rules and changes made by the Affordable Care Act.
Health Insurance Marketplace
The online marketplace where Michiganders can search for and purchase health insurance. Also called Health Care Exchange, HIX, Obamacare Exchange and Health Benefits Exchange. It's available at HealthCare.gov.
A free health insurance plan for children under age 19 and pregnant women.
The requirement that all Americans have health insurance in 2014. Those who do not comply face a fine (some exceptions apply).
Federal health care program provided to people whose household income is below 133 percent of the federal poverty level.
Federal health care program provided to those age 65 or over and younger people with disabilities.
Medicare benefits provided by a private insurance company.
A low-cost health insurance plan for children under age 19.
Minimum essential coverage
The level of health care coverage that all Americans are required to have in 2014 or pay a penalty (some exceptions apply).
See Affordable Care Act.
A health care provider with whom your insurance company has not negotiated a rate of payment. Seeing a doctor "out-of-network" can cost you more than seeing a doctor "in-network."
Expenses you have to pay yourself, above and beyond your insurance premiums. Typically includes copays and deductibles.
Patient's Bill of Rights
A group of new rights and protections for patients that was created alongside the health care law.
Personal insurance plan
An insurance plan purchased by an individual, not as part of an employer. Also called an individual plan.
A health issue that you already had that would sometimes disqualify you from getting insurance, or would cause your premiums to be increased. Under the new health care reform, insurance companies can no longer discriminate against those with pre-existing conditions or levy additional fees.
The rate you are charged for having active insurance. It is influenced by various factors, from age to health, and may be paid annually or in smaller installments over the year.
Primary care provider
A doctor, nurse practitioner or physician assistant who is the primary person you go to about your health care and is your go-to medical advisor.
Tax credits to help those who earn less than 400 percent of the federal poverty level buy insurance.
AARP, American Public Health Association, Centers for Medicare & Medicaid Services, Consumer Reports, FAIR Health, Inc., HealthCare.gov, Internal Revenue Service, Kaiser Family Foundation, Medicaid.gov, Michigan Department of Community Health, Michigan Department of Insurance and Financial Services, U.S. Chamber of Commerce, U.S. Department of Health and Human Services, U.S. Department of Veterans Affairs.
Every effort was made to provide clear, accurate information about health care reform. We verified any information we had with first-tier sources – those who are involved in this change and its effect on our health care system. We also relied on well-respected national nonprofits, some who've done a masterful job of providing clear information to consumers. Our primary source of information was the Affordable Care Act's official website, HealthCare.gov. If you need additional information about how health care reform affects you, that would be your best place to start.