Insurance terms

This is the formal name for the healthcare makeover law, also known as Obamacare. It aimed to make healthcare more affordable and accessible by introducing new rules for insurance companies, offering subsidies, and protecting against unfair insurance practices.

Platinum plans, one of the tiers of health insurance plans under the ACA, have higher monthly premiums but lower out-of-pocket costs when you need healthcare services.

Before getting admitted, your doctor might need to certify or confirm that your hospital stay is necessary for your treatment. This step ensures your insurance covers those costs.

Conditions or illnesses you had before getting insurance coverage are pre-existing conditions. Under the ACA, insurers can't deny coverage or charge more due to these conditions.

In PPO plans, you can see any doctor or specialist within the network without needing a referral. Going outside the network might cost you more, but staying in brings more savings.

A premium is the amount you pay, typically monthly, to your insurance company to maintain coverage. It's the insurance policy's cost, regardless of whether you use healthcare services.

Financial help from the government to lower your monthly health insurance costs, calculated based on income levels. For example, if you earn $40,000 per year, you might qualify for a premium subsidy that reduces your monthly premium from $200 to $10.

This tax break is designed to help lower-income people afford health insurance. It's like getting some money back during tax season to help cover the cost of your monthly health insurance premiums.

Your primary care provider is your go-to doctor for routine check-ups, coordinating your care, and referring you to specialists if needed.

Before your insurance approves coverage for particular services or drugs, your doctor might need prior authorization to ensure they're medically necessary.

This is a platform where individuals or businesses can shop for health insurance plans outside the official Health Insurance Marketplace.

Health insurance purchased directly from a private insurance company rather than through a government program. Benefits of private health insurance include a wider choice of doctors and hospitals, more flexibility in coverage, and some services that are not covered by government programs. Drawbacks are that it can be more expensive than government programs, may not cover pre-existing conditions, and may have higher deductibles and copays.

Providers are healthcare professionals who offer medical services. They include doctors, hospitals, clinics, and other healthcare entities providing care and services.

This is where individuals, families, and small businesses can shop for health insurance, often facilitated by the government.