WORDS USED WITH INSURANCE

Premiums: Monthly payments for insurance.

Deductibles: Amount person must spend on health care each year out of pocket before insurance begins to pay.

Co-pays: Amount person pays out of pocket at time of visit.

Cost sharing: Another term for deductibles and co-pays.

Subsidy: Portion of insurance premiums paid by the federal government as tax credits. When there is advanced payment of tax credits (APTC), the subsidy is paid directly to the insurance company. The federal subsidy lowers the cost of premiums for the individual.

Benefit package: List of services and treatments that are covered by insurance

METALLIC LEVELS FOR PLANS ON THE MARKETPLACE

The Marketplace organizes plans into “metallic levels” so that they can be compared more easily. The metallic levels are:

Platinum: Highest premiums, lowest cost sharing.

Gold: Higher premiums than silver plan, with lower cost sharing.

Silver: Standard plan. Tax credits are based on second lowest cost silver plan.

Bronze: Lowest premium, highest cost sharing.

All the plans have the same benefits. The plans may have different networks of providers.

YOU SHOULD ALSO KNOW ABOUT THE FEDERAL POVERTY LEVEL (FPL)

Federal Poverty Level (FPL) is based on income and family size. When your income and family size is compared to the FPL, it is used to determine whether you qualify for:

  • Medicaid
  • Child Health Insurance Program (CHIP)
  • Federal tax credits to pay for insurance premiums
  • A zero cost sharing plan if you are American Indian or Alaska Native

To see if your income and family size makes you eligible for these free or low cost health insurance programs,
Click here if you live in Alaska
Click here if you live in other states

FREQUENTLY ASKED QUESTIONS

Click here for answers to frequently asked questions about the Affordable Care Act.

MORE TERMS

ACA: Patient Protection and Affordable Care Act, P.L. 111-148 (the federal law that created Marketplaces for health insurance)

APTC: Advanced Payment of Tax Credits (the federal subsidy for premiums for health insurance purchased in a state or federal Marketplace)

CHIP: Child Health Insurance Program offered by States

FFM: Federally-facilitated Marketplace (also called Federally-facilitated Exchange or FFE), a website where people can purchase health insurance

MAGI: Modified Adjusted Gross Income (used to determine FPL) - based on income reported on federal tax returns, with some Tribal income not included for Medicaid eligibility.

MSP: Multi-State Plan - type of insurance offered in Marketplace

QHP: Qualified Health Plan - type of insurance offered in Marketplace