Grandmothered plans are individual and small-group health plans that took effect after the ACA was signed into law in 2010, but before the exchanges opened for business in 2013. (In some states, grandmothered plans include plans that were issued as late as the end of 2013.)| 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
In addition to the Platinum, Gold, Silver and Bronze individual health insurance plans, the ACA allows catastrophic plans for people under age 30, or for those 30 and older who qualify for a hardship exemption from having to maintain health insurance coverage or pay a penalty. But subsidies cannot be used to purchase these plans, so enrollment is very low.| 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
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
All plans (whether Bronze, Silver, Gold or Platinum) must cover the same essential benefits, including free preventive care; they all provide comprehensive coverage. But plans with the lowest premiums (Bronze, and to a lesser extent, Silver) require you to pay a larger share of your health costs. This means that your co-pays and deductibles will be higher, and your maximum out-of-pocket will generally be higher as well.| healthinsurance.org
