Stepping into the insurance world can be daunting. These 14 words can make those first steps easier.
Affordable Care Act:The
2010 federal health reform law has been generally upheld by the U.S.
Supreme Court. Its centerpiece is that everyone must purchase health
insurance unless they fall into a narrow area of exemptions. Those who
don't purchase insurance face penalties. The insurance can be purchased
online at a reduced rate on state exchanges. In a lingering challenge to
the controversial law, the U.S. Supreme Court must still decide whether
the federal government can provide subsidies to reduce the cost of
coverage in states that chose not to operate their own state exchanges.
In those states, the federal government is running them. That includes
Michigan.
Catastrophic plans:These
plans offer low premiums, but have very high out-of-pocket costs for
co-pays and deductibles. They're available only to consumers under 30 or
consumers with a "hardship exemption" — those whom the marketplace has
determined are unable to afford other health coverage. Though they also
cover some preventive care, the goal of these plans is to guard against
worst-case scenarios.
Co-payment: A fixed cost — for example, $20 — that consumers pay for certain health services, such as a doctor's visit.
Coinsurance:A percentage of the cost — for example, 20% — that consumers pay for certain health services, such as a doctor's visit.
Deductible: The
amount a consumer pays for health insurance before the insurer begins
to pay. For example, if a plan's deductible is $1,000, the consumer pays
that amount first before coverage kicks in. The deductible may not
apply to all services.
Healthy Michigan: The
state's new Medicaid program. Generally, a family is eligible if it has
an income at or below 133% the federal poverty limit. As it stands now,
that's about $15,521 for an individual or $31,721 for a family of four.
King v. Burwell: The
case before the U.S. Supreme Court that is challenging tax credits used
to reduce premiums in states such as Michigan — those in which the
state declined to run its own state marketplace and, by default, turned
it over to the federal government's www.healthcare.gov web site.
Metal levels:Five
categories of insurance plans — platinum, gold, silver, bronze and
catastrophic — that indicate roughly the percentage of cost the consumer
will have to cover. For example, a platinum plan generally has higher
monthly premiums but covers about 90% of the cost of care, while a
bronze plan is less costly each month but consumers will pay more when
they seek care.
Michigan health insurance marketplace: The
state's exchange. Michigan lawmakers decided against the state running
its own operation, so Michigan is one of 36 states where consumers
access plans through the federally facilitated www.healthcare.gov.
Narrow networks: These
plans are being offered more frequently across the U.S. and in
Michigan. They offer lower monthly premiums that can save consumers
thousands of dollars. The trade-off: The consumer pays full price for
any care provided outside the network (except in emergencies).
Out-of-pocket costs: The
consumer's share of health costs, including deductibles, coinsurance
and co-payments for covered services, in addition to costs for services
that aren't covered.
Small Business Health Options (SHOP): The
marketplace that helps small businesses and nonprofit organizations —
those with 50 or fewer full-time equivalent employees (FTEs) — provide
health coverage to employees. Businesses with fewer than 25 employees
may qualify for tax credits. Firms with 100 or fewer FTEs can use the
SHOP in 2016.
Small Business Health Care Tax Credits:Federal
financial assistance that reduces costs for small businesses — those
with fewer than 25 full-time employees — in providing coverage to
employees if the average employee salary is about $50,000 or less.
Another qualifier: The employer must pay at least 50% of the full-time
employees' premiums. A tax credit calculator is available at www.healthcare.gov.
Premium: The
cost for a health plan. It's usually paid by the consumer or employer
monthly or quarterly. It does not count toward meeting a deductible. (http://www.freep.com)
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