Grandfathered plans are health plans that were already in effect as of March 23, 2010, when the Affordable Care Act was signed into law. In the individual market, they are plans that already covered the policyholder as of that date, and in the employer-sponsored market, they are plans that the employer had already implemented as of that date, and has continuously offered ever since, with at least one covered employee at all times.| healthinsurance.org
Cost-sharing refers to the fact you – as a health insurance policy holder – and your health insurance company share in the cost of your covered health care services.| healthinsurance.org
As of the 2025 plan year, there will be 20 fully state-run health insurance marketplaces (SBMs), three state-based marketplaces that use the federal platform (SBM-FP), and 28 fully federally run marketplaces. Three of the SBMs had an SBM-FP model in 2021, but transitioned to their own enrollment platforms as of the 2022 plan year. Virginia joined them in the fall of 2023, and Georgia will also be running its own exchange platform by the fall of 2024. Illinois has enacted legislation to creat...| 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
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 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