Reference
ACA glossary
Plain-English definitions for the terms you'll see on the marketplace, on bills, and in this site.
No cost, no obligation. Brokers are paid by the carrier and can compare plans side-by-side for your situation.
Request a broker →Percentage of total covered medical costs the plan pays on average. Bronze ≈ 60%, Silver ≈ 70%, Gold ≈ 80%, Platinum ≈ 90%.
Premium tax credit paid in advance to your insurer each month to lower your premium.
Maximum amount your insurer considers reasonable for a covered service.
Provider billing you for the difference between charge and allowed amount. Banned by the No Surprises Act for most emergency and out-of-network situations.
Second-lowest-cost Silver plan in your area. Sets the dollar value of your APTC.
Children's Health Insurance Program. Low- or no-cost coverage for kids in households that earn too much for Medicaid.
Your share of a service's cost after meeting the deductible, expressed as a percentage.
Fixed dollar amount you pay for a covered service, usually at the time of service.
Lowered deductibles, copays, and OOP max on Silver plans for households under 250% FPL.
Amount you pay for covered services before your insurer starts paying.
10 categories of services all marketplace plans must cover (e.g., ambulatory, hospital, maternity, mental health, Rx, pediatric).
On a family plan, each member has their own deductible that counts toward a higher family deductible.
Federally Facilitated Marketplace — HealthCare.gov.
List of drugs your plan covers, organized in tiers.
Federal Poverty Level — HHS-published household income thresholds used to determine subsidy eligibility.
High-Deductible Health Plan that meets IRS rules so members can contribute to an HSA.
Health Reimbursement Arrangement. Employer-funded, tax-free account to reimburse medical expenses or premiums.
Health Savings Account. Triple-tax-advantaged personal account paired with an HDHP.
Individual Coverage HRA. Lets employers reimburse employees tax-free for individual market premiums instead of offering a group plan.
Providers that have contracted with your insurer for negotiated rates.
Modified Adjusted Gross Income. For ACA: AGI + tax-exempt interest + untaxed Social Security + excluded foreign income.
ACA option for states to extend Medicaid to adults up to 138% FPL with federal cost share.
Bronze, Silver, Gold, or Platinum — categorizes plans by actuarial value.
Annual window when anyone can enroll or change marketplace plans. Federal for plan year 2027: Nov 1 – Dec 15 (shortened by the 2025 Marketplace Integrity Rule; no state may extend past Dec 15).
The most you'll pay in a plan year for covered, in-network services. Premiums don't count toward this.
Monthly amount you pay for coverage, regardless of whether you use services.
Qualified Health Plan. Marketplace-certified plan covering essential health benefits.
State-Based Exchange (runs its own platform) / State-Based Exchange on the Federal Platform (uses HealthCare.gov tech).
60-day window triggered by a qualifying life event (move, marriage, loss of coverage, etc.).
Practice of loading the cost of CSRs onto Silver premiums after federal CSR payments ended in 2017. Inflates Silver premiums and APTC.
Pre-ARPA rule cutting off all APTC above 400% FPL. Suspended through 2025; may return.
The information contained on this website is for educational purposes only. We are not responsible for missing or inaccurate information. Please consult a licensed insurance broker in your state and area for insurance advice. Please consult a CPA for tax or legal advice.