Healthcare terms

A tax credit that you can take in advance to lower your monthly health insurance payment.

Also known as Obamacare, this health care reform law was launched in March 2010 to make affordable health insurance available to more people, expand Medicaid, and support new medical care delivery methods designed to lower healthcare costs.

• The largest amount an insurance plan will pay for a covered health care service. It may also be called an eligible expense, a payment allowance, or a negotiated rate.

Each Health Insurance Marketplace application has a unique identification number, or Application ID. After you apply for Marketplace coverage, you’ll get a notice with your eligibility results that have your Application ID. You'll need your Application ID to continue with an existing application, compare plans, and complete enrollment. If you are doing this by phone, you can provide your Application ID to the Marketplace Call Center representative so they can find your application faster. If you're continuing your application, comparing plans, and enrolling online, you'll be asked to enter your Application ID after you log in to your account.

When you apply for health coverage through the Marketplace, you're required to agree (attest) to the truth of the information provided by signing the application.

The organization of all your healthcare treatment and appointments.

The federal agency that runs Medicare, Medicaid, and Children's Health Insurance programs and the federally helped Marketplace.

Someone who has been trained to help consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including helping them complete eligibility and enrollment forms. Their services are free to consumers.

A joint federal and state insurance program that provides free or low-cost health coverage to children and pregnant women in families that earn too much to qualify for Medicaid.

The amount you pay for a service that is covered by a health insurance plan.

When information that you put on your Marketplace health insurance application is different from information from other trusted data sources. For instance, if you put your middle name in one place and just your middle initial somewhere else.

How much you’ll pay for certain covered healthcare services and items each year before your plan starts to pay (except free preventive services).

A child or other individual for whom a parent, relative, or other person may claim a deduction from a personal exemption tax. Under the Affordable Care Act, individuals may be able to claim a premium tax credit to help cover the cost of coverage for themselves and their dependents.

A limit to a range of major life activities. This includes seeing, hearing, walking, thinking, and working. Because different programs may have different disability standards, please check the program you're interested in for its disability standards.

The ability for certain individuals to enroll in both Medicare and Medicaid, allowing them to receive comprehensive health coverage and help with out-of-pocket costs. These "dual eligibles" often include older adults or people with disabilities who qualify for Medicaid due to low income and assets.

An immigration status that's considered eligible for getting health coverage through the Marketplace. The rules for eligible immigration status may be different in each insurance affordability program.

A measure of income updated each year by the Department of Health and Human Services (HHS) that’s used to decide eligibility for certain programs and benefits like Marketplace savings and Medicaid and the Children's Health Insurance Program (CHIP) coverage.

Federally funded nonprofit health centers or clinics. Federally qualified health centers provide primary care services regardless of your ability to pay. Services are provided on a sliding scale fee based on your insurance status and ability to pay.

An agency within the U.S. Department of Health and Human Services that protects public health by assuring the safety and effectiveness of drugs, vaccines, and other products.

A brief period after your monthly health insurance payment is due during which you can still pay all owed premiums and avoid losing coverage.

Health Insurance Portability and Accountability Act of 1996, a U.S. federal law designed to protect sensitive patient health information from being shared without consent.

Your household is you, your spouse, and your tax dependents. Your eligibility for savings is based on the income of all household members, even those who don’t need insurance.

Individuals or organizations that are trained and able to provide help to consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including helping them complete eligibility and enrollment forms. These individuals and organizations must be unbiased. Their services are free to consumers.

Individuals who have qualified non-citizen immigration status without a waiting period or other specific statuses.

Shorthand for the “Health Insurance Marketplace – a shopping and enrollment service for health insurance created by the Affordable Care Act in 2010.

A joint federal and state insurance program that provides free or low-cost health coverage to some low-income individuals, families, children, pregnant women, the elderly, and people with disabilities.

The figure used to decide eligibility for premium tax credits and other savings for Marketplace health insurance plans and for Medicaid and the Children's Health Insurance Program (CHIP). MAGI is adjusted gross income (AGI) plus these, if any: untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest.

An individual or organization that's trained to help consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including completing eligibility and enrollment forms. These individuals and organizations must be unbiased. Their services are free to consumers.

The department that oversees public health in New York State. It promotes the prevention and control of disease, environmental health, healthy lifestyles, and emergency preparedness and response.

A prescription and non-prescription drug program for Medicaid members in New York State.

A provider who doesn’t have a contract with your health insurance. If you have services with this provider, you’ll pay more to see a non-preferred provider. Check your policy to see if you can go to all providers who have contracted with your health insurance or plan, or if your health insurance or plan has a “tiered” network and you must pay extra to see some providers.

During this time, you can sign up for, renew, or change plans for the upcoming year.

Costs you pay when you get a service covered by your plan (like deductibles, co-pays, and coinsurance) plus all costs for any items not covered by your plan.

Each Marketplace health plan has a unique 14-character identifier that's a combination of numbers and/or letters.

A health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts. Insurance companies can't refuse to cover treatment for your pre-existing condition or charge you more.

You pay a monthly amount for coverage whether you get services or not.

Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems

Health services that cover a range of prevention, wellness, and treatment for common illnesses. Primary care providers include doctors, nurse practitioners, and physician assistants. They often keep long-term relationships with you and advise and treat you on a range of health-related issues. They may also coordinate your care with specialists.

The doctor, nurse practitioner, or physician assistant you see on a regular basis for primary care visits.

Approval from a health plan that may be needed before you get a service or fill a prescription for the service or prescription to be covered by your plan.

An insurance plan that’s certified by the Health Insurance Marketplace to provide essential health benefits, follow established limits on cost-sharing (like deductibles, copayments, and largest out-of-pocket amounts), and meet other requirements under the Affordable Care Act. All qualified health plans meet the Affordable Care Act requirements for health coverage, known as “minimum essential coverage.”

An event like getting married, having a new baby or dependent, moving, or losing health coverage that allows you to change insurance outside of the open enrollment period.

A written order from your primary care provider for you to see a specialist or get certain medical services.

A geographic area where a health insurance plan accepts members if it limits membership based on where people live. For plans that limit which doctors and hospitals you may use, it's also generally the area where you can get routine (non-emergency) services. The plan may end your coverage if you move out of the plan's service area.

Routine visits for comprehensive preventive health services that occur when a baby is young and annual visits until a child reaches age 21. Services include physical exam and measurements, vision and hearing screening, and oral health risk assessments.

A health benefit that at least partially covers vision care, like eye exams and glasses. All plans in the Health Insurance Marketplace include vision coverage for children. Only some plans include vision coverage for adults.

Care for an illness, injury, or condition serious enough that a reasonable person would seek care right away, but not so severe it requires emergency room care.

Food benefits for low-income families to supplement their grocery budget so they can afford the nutritious food essential to health and well-being.

A specialized type of Medicare Advantage plan for people with specific diseases, chronic conditions, dual eligibility (Medicare and Medicaid), or living in an institution.