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Insurance encyclopedia for clearer coverage decisions.
Use these plain-English definitions to understand common terms before you compare coverage or call for licensed help.
DeductibleA deductible is the amount you may need to pay for covered services before certain insurance benefits begin paying, depending on the plan and service type.CopayA copay is a set dollar amount you may pay for a covered service, such as a doctor visit, prescription, urgent care visit, or specialist appointment.CoinsuranceCoinsurance is a percentage share of covered costs that you may pay after plan rules are applied, often after a deductible is met.PremiumA premium is the regular amount paid to keep an insurance policy active, usually monthly, before separate costs such as deductibles or copays are considered.Out-of-pocket maximumAn out-of-pocket maximum is the most you may pay for covered in-network services during a plan year before the plan pays covered costs at a higher level.HMOAn HMO, or Health Maintenance Organization, is a plan structure that often uses a defined provider network and may require referrals for some specialist care.PPOA PPO, or Preferred Provider Organization, is a plan structure that may offer more provider flexibility than some network types, subject to plan rules and costs.EPOAn EPO, or Exclusive Provider Organization, is a plan structure that usually focuses coverage on a specific network except for emergencies.ACAACA refers to the Affordable Care Act, the federal health law tied to marketplace coverage, essential health benefits, subsidies, and protections for pre-existing conditions.MedicareMedicare is a federal health insurance program mainly for people age 65 or older and certain younger people with qualifying disabilities or conditions.MedicaidMedicaid is a public health coverage program for eligible people with limited income or specific qualifying circumstances, with rules that vary by state.MedigapMedigap, also called Medicare Supplement insurance, is private coverage designed to help pay certain costs left after Original Medicare.Part DPart D is Medicare prescription drug coverage offered through private insurance companies approved by Medicare, either standalone or tied to certain plans.SEPSEP means Special Enrollment Period, a limited window that may let someone enroll in or change coverage after certain qualifying life events.Open EnrollmentOpen Enrollment is a scheduled period when many people can enroll in, renew, or change certain insurance coverage for the next plan period.Life insuranceLife insurance is coverage designed to pay a death benefit to beneficiaries if the insured person dies while the policy is active and payable.Term lifeTerm life insurance provides life coverage for a set period, such as 10, 20, or 30 years, if premiums are paid and policy terms are met.Whole lifeWhole life insurance is permanent life insurance designed to remain in force for life if required premiums are paid and policy rules are met.Hospital indemnityHospital indemnity coverage is supplemental insurance that may pay a set benefit for certain hospital stays or related events, depending on policy terms.Critical illnessCritical illness insurance is supplemental coverage that may pay a benefit after certain covered diagnoses, subject to policy definitions and exclusions.
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