Accountable Care Organization: A network or group of healthcare providers— including primary care doctors, specialists, and hospitals—that provides the full range of medical services. The providers work together to coordinate patients' medical care and chronic disease management. The network’s ability to control costs and provide quality care determines the payment it receives.
Advanced Premium Tax Credit: A tax credit to help pay for health insurance purchased through a health insurance exchange, or marketplace (see below). To qualify, you must submit income and employment information. The insurance marketplace estimates your tax credit based on the information you provide.
The tax credit will be applied to your insurance premium cost. The credit goes directly to the insurance company to lower your premium payment. When you file a federal income tax return, your actual income for the year determines your final tax credit. If your estimate was less than your actual credit, you will receive the balance as a refund. However, if your estimate exceeded your actual credit, you must repay the amount as tax due.
Cost Sharing: The concept of individuals or families paying a portion of their healthcare costs directly to healthcare providers for medical services. Examples include co-pays and deductibles.
Deductible: The amount of money an individual must pay toward healthcare costs before health insurance begins to pay.
Employer Shared Responsibility Payment: A tax penalty that employers with 50 or more employees must pay if they do not provide healthcare coverage for their full-time employees and their dependents. Full-time employees are those working 30 hours per week or more. The penalty also applies if these employers fail to provide health insurance coverage that meets minimum requirements. The federal government has delayed this provision of the ACA, also called the employer mandate, until January 2015.
Essential Health Benefits: Ten categories of care that must be part of any health plan offered through an insurance marketplace. This includes coverage for ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, pediatric services, and preventive and wellness services and chronic disease management.
Federal Poverty Level: The income level that the federal government sets each year to define poverty among U.S. residents. The government uses this guideline to determine who is eligible for public assistance programs. In 2013, the federal poverty level is $11,490 for a single person and $23,550 for a family of four.
Health Insurance Exchange: This is another name for the health insurance marketplace, where people and small businesses will be able to buy insurance. Insurers will offer plans on the exchange/marketplace, and customers can compare costs and services to choose the plan that is right for them. The exchange/marketplace also will help eligible low- and middle-income individuals and families apply for assistance. Consumers can access the exchange/marketplace online or with the help of a representative called a navigator.
Health Insurance Marketplace: This is another name for the health insurance exchange, where people and small businesses will be able to buy insurance. Insurers will offer plans on the marketplace, and customers can compare costs and services to choose the plan that is right for them. The marketplace also will help eligible low- and middle-income individuals and families apply for assistance. Consumers can access the marketplace online or with the help of a representative called a navigator.
Health Maintenance Organization (HMO): A type of health insurance that pays for care only from healthcare providers who have a contract with that HMO. In most cases, an HMO will pay for out-of-network care only in an emergency. Often, there's an emphasis on preventive care and wellness services.