A health insurance deductible is the amount an individual must pay for healthcare expenses before insurance (or a self-insured company) covers the costs. Often, insurance plans are based on yearly deductible amounts.| healthinsurance.org
Coinsurance refers to money that an individual is required to pay for services, after a deductible has been paid. Coinsurance is often specified by a percentage.| healthinsurance.org
If you're like the vast majority of consumers, you may be hearing about CSRs for the first time and wondering why these subsidies are so important, and whether they actually affect your own coverage. Here's what you need to know:| healthinsurance.org
An out-of-pocket maximum is a predetermined, limited amount of money that an individual must pay before an insurance company or (self-insured employer) will pay 100% of an individual's covered, in-network health care expenses.| healthinsurance.org
The monthly premiums you pay in order to have coverage are not included in out-of-pocket costs. Out-of-pocket costs are only incurred if and when you need medical care, whereas premiums have to be paid every month, regardless of whether you need medical care or not.| healthinsurance.org
An off-exchange plan is a health insurance policy that is purchased directly from an insurance company or through an agent or broker, outside of the official ACA-created health insurance exchange.| healthinsurance.org
A cost-sharing reduction (CSR) is a provision of the Affordable Care Act that reduces out-of-pocket costs for eligible enrollees who select Silver health insurance plans in the marketplace. CSRs – often referred to as cost-sharing subsidies – reduce enrollees' cost-sharing by lowering a health plan's out-of-pocket maximum, and increasing the actuarial value (AV) of the plan.| healthinsurance.org
There are two different meanings for the term benchmark plan – and both have to do with the Affordable Care Act: Benchmark plan is the term used to describe the second-lowest-cost Silver plan (SLCSP) available in the exchange/Marketplace, and it’s also the term for the plan that each state designates as the standard for essential health benefits (EHBs).| healthinsurance.org
Need more info about Medicaid in your state? Get updated information on the current status of Medicaid expansion, along with general information about each state’s program.| healthinsurance.org
See if you're eligible for the Affordable Care Act's premium tax credits (premium subsidies), how subsidies are calculated, and why they are more robust in 2023.| healthinsurance.org
While the Affordable Care Act's premium subsidies help pay the cost of the health insurance itself, cost-sharing subsidies help to reduce out-of-pocket spending for eligible enrollees when they select Silver plans. The Trump administration eliminated federal funding for cost-sharing reductions, but the benefits are still available to eligible enrollees. And because the cost of cost-sharing reductions has been added to premiums, premium subsidies are much larger than they were prior to 2018.| healthinsurance.org
Under the Affordable Care Act, eligibility for Medicaid, premium subsidies, and cost-sharing reductions is based on modified adjusted gross income (MAGI). But the calculation for that is specific to the ACA – it's not the same as the MAGI that's used for other tax purposes| healthinsurance.org
The Affordable Care Act standardized individual health insurance policies by creating a “metal” ranking for individual/family and small-group policies, based on their actuarial value (the percentage of costs that the plan pays across a standard population).| healthinsurance.org
A list of the open enrollment deadlines for enrollment in 2025 ACA-compliant health insurance in every state. Open enrollment runs from November 1 to January 15 in most states, but some state-run exchanges have different schedules.| healthinsurance.org
Learn how the Affordable Care Act (Obamacare) improved health coverage and made it more affordable through income-based subsidies.| healthinsurance.org
The ACA's subsidy cliff has been temporarily eliminated (through 2025), saving some health insurance buyers thousands of dollars per year.| healthinsurance.org
Find out if you qualify for lower costs on Marketplace health insurance coverage at HealthCare.gov.| HealthCare.gov
