Insurance terms

This is another name for the Affordable Care Act (ACA), which aimed to make healthcare more accessible and affordable. It introduced features like marketplaces, subsidies, and protections against denial based on pre-existing conditions.

These plans come in different tiers — bronze, silver, gold, and platinum — each with varying costs and coverage levels. Bronze plans usually have lower premiums but higher out-of-pocket costs, while platinum plans have higher premiums but lower out-of-pocket expenses.

These are health plans bought directly from insurance companies or brokers outside the official Health Insurance Marketplace. They might offer similar coverage but without marketplace perks like tax credits.

With these plans, you don't need a referral to see specialists; you can directly access them within your network.

This is the window of opportunity for you to get insurance and receive subsidies. Open Enrollment is when individuals can enroll in or change health insurance plans. It's a designated time frame each year to sign up for coverage through the Health Insurance Marketplace or employer-sponsored plans.

This coverage helps when you're away from your usual network area. It ensures you're still covered when you are traveling.

Out-of-network refers to healthcare providers who don't have agreements with your insurance company. Getting services from out-of-network providers may result in higher costs or lower coverage except in the case of specific emergencies. You trade higher costs for flexibility.

These are healthcare providers who are not in the network of your insurance plan. Seeing them might mean paying more from your own pocket, since they don't have agreements with your insurer for discounted rates.

These are your expenses beyond the premium you pay. Out-of-pocket costs are the expenses you pay for healthcare services not covered by insurance. This includes deductibles, copayments, and coinsurance and can have limits like an out-of-pocket maximum.

This refers to the most you will pay for covered health care in a year. After you hit this limit, your insurance covers 100% of costs.

These are any healthcare services or treatments that don't require you to stay overnight in a hospital.

These are medications you can buy without a prescription. They are available at pharmacies or online for common health issues such as headaches or colds. Whether your health insurance covers the cost of over-the-counter medications depends on several factors, like the type of health insurance plan, the type of OTC drug, and whether a doctor prescribes the medicine. Ultimately, the best way to determine whether your health insurance plan covers OTC medications is to contact your insurance company directly.