Health insurance terms can sound similar but mean different things. Search or browse these plain-language definitions to understand common plan documents and compare the details that matter.
Advance premium tax credit
A tax credit paid in advance to an insurer to reduce what eligible Marketplace enrollees pay each month, subject to reconciliation.
Annual deductible
The amount you pay for certain covered services before the plan begins paying its share.
Bronze plan
A Marketplace metal category that generally has lower premiums and higher costs when you receive care than richer categories, though plan details vary.
Catastrophic plan
A plan category with specific eligibility rules and high deductibles; availability and suitability depend on the individual situation.
Coinsurance
A percentage of the allowed cost of a covered service that you pay.
Copayment
A fixed amount you pay for a covered service or prescription under the plan terms.
Cost-sharing reduction
Additional savings that lower deductibles and other out-of-pocket costs for eligible people who enroll in a qualifying Silver plan.
Deductible
The amount you pay for certain services before the plan starts sharing those costs.
Essential health benefits
A set of benefit categories ACA-compliant individual and small-group plans must cover, subject to applicable rules.
Form 1095-A
The Marketplace Health Insurance Statement that provides information about Marketplace coverage and advance premium tax credits.
Form 8962
The IRS form used to calculate and reconcile the Premium Tax Credit when applicable.
Gold plan
A Marketplace metal category that generally has higher premiums and lower costs when receiving care than Bronze plans, subject to plan specifics.
In-network provider
A provider that participates in the plan network for the particular plan and service.
Marketplace
The federal or state-based platform where consumers can apply for qualifying individual or family health coverage.
Metal categories
Bronze, Silver, Gold, and Platinum categories that describe average cost-sharing levels, not quality of care.
Open Enrollment
The yearly window when eligible consumers can enroll in or change Marketplace plans.
Out-of-pocket maximum
A yearly limit on covered cost-sharing for eligible in-network covered services; premiums and some other costs are excluded.
Platinum plan
A Marketplace metal category that generally has higher premiums and lower costs when receiving care compared with Bronze plans.
Premium
The amount paid to keep the insurance policy active, usually monthly.
Premium tax credit
A federal tax credit that eligible consumers may use to lower Marketplace premium costs, subject to current requirements.
Provider network
The doctors, hospitals, pharmacies, and other providers that have agreements with a plan.
Qualified health plan
A health plan certified to be offered through a Marketplace and meeting applicable requirements.
Silver plan
A Marketplace category with cost-sharing characteristics between Bronze and Gold plans; eligible consumers may receive extra cost-sharing reductions in Silver plans.
Special Enrollment Period
An opportunity to enroll or change plans outside Open Enrollment after certain qualifying events and if applicable requirements are met.
Summary of Benefits and Coverage
A standardized document describing important features and costs of a health plan.
Tax household
The person or group of people considered together under applicable tax rules for certain Marketplace calculations.
Definitions are educational summaries. The wording and application of a term can vary by plan document or applicable rule, so read the official plan materials for your own coverage.