Glossary of terms regarding the Affordable Health Care Act
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- Children’s Health Insurance Program-
Insurance program jointly funded by state and federal government that provides health coverage to low-income children and, in some states, pregnant women in families who earn too much income to qualify for Medicaid but can’t afford to purchase private health insurance coverage.
- COBRA- A Federal law that may allow you to temporarily keep health coverage after your employment ends, you lose coverage as a dependent of the covered employee, or another qualifying event. If you elect COBRA coverage, you pay 100% of the premiums, including the share the employer used to pay, plus a small administrative fee.
- Employer Sponsored Plan-
Coverage that is offered to an employee (and often his or her family) by an employer.
- Flexible Spending Account (FSA)-
A Flexible Spending Account is a special account you put money into that you use to pay for certain out-of-pocket health care costs. You don’t have to pay taxes on this money. This means you’ll save an amount equal to the taxes you would have paid on the money you set aside. An FSA is available only with employer based plans.
- Government sponsored plan-
Health insurance provided by the government. Examples include Medicaid, CHIP, and Veterans Benefits.
- Health Insurance Exchange-
See Health Insurance Marketplace
- Health Insurance Marketplace-
A resource where individuals, families, and small businesses can learn about their health coverage options; compare health insurance plans based on costs, benefits, and other important features; choose a plan; and enroll in coverage. The Marketplace also provides information on programs that help people with low to moderate income and resources pay for coverage. This includes ways to save on the monthly premiums and out-of-pocket costs of coverage available through the Marketplace, and information about other programs, including Medicaid and the Children’s Health Insurance Program (CHIP). The Marketplace encourages competition among private health plans, and is accessible through websites, call centers, and in-person assistance. In some states, the Marketplace is run by the state. In others it is run by the federal government.
- Health Insurance Penalty (Fee)-
Starting January 1, 2014, if someone doesn't have a health plan that qualifies as minimum essential coverage, he or she may have to pay a fee that increases every year: from 1% of income (or $95 per adult, whichever is higher) in 2014 to 2.5% of income (or $695 per adult) in 2016. The fee for children is half the adult amount. The fee is paid on the 2014 federal income tax form, which is completed in 2015. People with very low incomes and others may be eligible for waivers.
- Individual (Health Care) plan-
Insurance plan that you purchase yourself the Health Insurance Marketplace and it is not from your employer.
A state-administered health insurance program for low-income families and children, pregnant women, the elderly, people with disabilities, and in some states, other adults. The Federal government provides a portion of the funding for Medicaid and sets guidelines for the program. States also have choices in how they design their program, so Medicaid varies state by state and may have a different name in your state.
A Federal health insurance program for people who are age 65 or older and certain younger people with disabilities. It also covers people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
- Medicare Part D donut hole-
Most plans with Medicare prescription drug coverage (Part D) have a coverage gap (called a "donut hole"). This means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit. Once you have spent up to the yearly limit, your coverage gap ends and your drug plan helps pay for covered drugs again.
- Minimum Essential Coverage-
The type of coverage an individual needs to have to meet the individual responsibility requirement under the Affordable Care Act. This includes individual market policies, job-based coverage, Medicare, Medicaid, CHIP, TRICARE and certain other coverage.
Open Enrollment Period- period of time during which eligible individuals can enroll in a Qualified Health plan in the marketplace. In 2014, the Open Enrollment Period is October 1, 2013- March 31, 2014. For 2015 and later years, the Open Enrollment Period is October 15 to December 7 of the previous year. Individuals may also qualify for Special Enrollment Periods outside of Open Enrollment if they experience certain events. (See Special Enrollment Period and Qualifying Life Event)
Qualifying Life Event- A change or interruption in your life than makes you eligible for a Special Enrollment Period to enroll in health coverage. Examples include moving to a new state, changes in your income, and changes in your family size (marry, divorce, have a baby, or become pregnant).
Special Enrollment Period- Time outside open enrollment period during which you and your family have a right to sign up for job based health coverage. Job based plans must provide a special enrollment period of 30 days following certain life events that involve a family status (examples include marriage or birth of a child) or loads of other job based health coverage.
A health care program for active-duty and retired uniformed services members and their families.