Glossary

ACA (n.): See Patient Protection and Affordable Care Act. Ever heard of Obamacare? This is it.

AHCA (n.): See the American Health Care Act. This was the House proposed replacement for Obamacare. 

APR (n.): See Annual Percentage Rate.

Affordable Care Act (n.): See Patient Protection and Affordable Care Act. It’s also called Obamacare. We bet you’ve heard of it.

American Health Care Act (n.): A United States House bill to repeal the Patient Protection and Affordable Care Act, (i.e. Obamacare.) 

Annual Percentage Rate (n.): Also known as APR. A yearly percentage of your whole loan that you pay to the lender. So it’s like: if you borrowed ten bucks from your brother for a comic book when you were a kid, it took you a year to pay it back, and he charged you a dollar for the loan, your APR would be 10%. (Which is exactly why you should have asked grandma. She’d have just given you the darn thing.)

Benefits (n.): The word ‘benefits’ is used in a few different ways, but they’re related. You could talk about employer benefits or just health benefits.

  1. Employer benefits. Things you get from your employer that aren’t cash. Things like: free donuts in the kitchen, company rain jackets, payment of your health insurance policies, matches to your charitable donations or retirement contributions, and sweet branded coffee mugs. Fun fact: Sometimes employer health insurance benefits are mandated by law.
  2. Health insurance benefits: When your healthcare costs (or part of them) are covered by an insurance company, you have health insurance benefits. This just means the insurance company pays part of your costs. Your benefits — the part they’ll pay — are determined by a contract you sign with them called a health insurance policy.

Coinsurance (n.): Kind of like copayment. When you have a health insurance policy, you split your healthcare bills with your health insurance company. The part that you pay may be called either coinsurance or copayment, depending on your policy. If it’s coinsurance, it’s usually a percentage of your bill. Think about it this way: you’re going halfsies with your buddies for dinner, except they’re (hopefully) paying a bigger half! You pay your coinsurance after your premium and your deductible.

Coverage (n.): The amount of money you’re given by your health insurance policy to help pay your medical bills.

Claim (n.): Your request to your health insurance company that they pay the amount they’ve agreed to put toward your healthcare bill. You have to submit a claim before your health insurance company will pay their part of the costs. Often your doc will submit a claim on your behalf, but not always.

Copayment (Copay) (n.): Similar to coinsurance. When you have a health insurance policy, you split your healthcare bills with your health insurance company. The part that you pay may be called either coinsurance or copayment, depending on your policy. If it’s a copayment, it’s usually a flat fee. Think: $25 for an office visit. That’s your copay. You pay your copay after your premium and your deductible.

Deductible: (n.): Money that you have to pay toward your medical bills before an insurance company will split any remaining costs with you. Deductibles can be different amounts; they just depend on your plan.

Enrollment Period (n.): A limited time period, often a few months, during which you can either enroll in a new health insurance policy or make changes to the one you have. The most well-known kind of enrollment period is the Open Enrollment Period, during which you can buy or change policies on the federal Health Insurance Marketplace established by the Affordable Care Act. Think of changing health insurance like hunting; you can only do it at a certain time of year. But there are fewer deer involved.

Essential Health Benefit (n.): One of 10 kinds of healthcare services that must be covered by health insurance policies because of the Affordable Care Act.

Essential health benefits include:

  • Ambulance rides 
  • Emergency services
  • Hospitalization 
  • Maternity and newborn care 
  • Mental health and substance use disorder services, including behavioral health treatment 
  • Prescription drugs 
  • Rehabilitative services and devices 
  • Laboratory services 
  • Preventive and wellness services and chronic disease management 
  • Pediatric services, including teeth and eye care

So, if you go rock climbing in Asheville, fall off the mountain, call an ambulance, head to the hospital, and have to check in for a few days, don’t worry — it’s all covered except for the damage to your ego!

Fiscal Health (n.): North Carolina health care policy issues as they affect the inter-related financial states of individuals, their businesses and their communities. Also: our goal and entire purpose for being!

Health Insurance (n.): A service offered by companies that help you pay for your healthcare. They do it for a fee called a premium. What they’ll pay for and when is covered in an agreement between you and them called a health insurance policy. You know how you give Netflix some money every month and then you can Netflix and chill to your heart’s content? It’s like that, except with doctor’s visits. (Much less fun, we know.)

Health Insurance Exchange (n.): See Health Insurance Marketplace.

Health Insurance Marketplace (n.): The federal resource that lets you research, compare, and buy health insurance policies. You can get to the Marketplace through their website. The Marketplace was established by the Patient Protection and Affordable Care Act. Think about it like a farmer’s market, except with fewer tomatoes and a lot more fine print. Oh, and the farmers are required to sell you things.

Health Insurance Plan (n.): See health insurance policies.

Health Insurance Policy (n.): An agreement between you and a health insurance company that lays out the amount of money the company will pay for your healthcare costs and the kinds of services they’ll pay for. Health insurance policies usually apply yearly. They have to be renewed every year during an enrollment period. (Don’t worry. This will probably be an automatic process.) So here’s how it works: you sign something, pay a premium every month, and then when you go to the doctor your health insurance company helps you pay the bills. (After you pay your out-of-pocket expenses, of course. Which seems like a lot to remember, but you’ll get it down.)

Individual Retirement Account (n.): Also known as an IRA. A kind of investment account that helps you save for retirement. Here’s how it works: before the government taxes your income, you put some of it into your IRA so that they can’t touch it. Better yet, you can sometimes even deduct the amount you put in your IRA from your taxes — it’s sort of a double tax bonus! The only downside: there’s usually a yearly limit to the amount you’re allowed to put in your IRA. Bummer.

Interest Rate (n.): A percentage. A percentage of a loan that a lender charges you for the service, to be specific. When you pay back the loan, you pay back the principal (that’s the loan itself) plus interest—the amount you owe according to the interest rate. See how it works?

IRA (n.): See Individual Retirement Account.

Mandate (n.): A law that requires a health insurance company to pay for stuff: certain healthcare providers, benefits, or patient populations.

Mandated (v.): Required by law. (Or by your spouse. Which is basically law. #justkidding #butseriouslythough)

Obamacare (n.): See Patient Protection and Affordable Care Act.

Open Enrollment Period (n.): The time period, usually three months in the fall and winter, during which plans on the federal Health Insurance Marketplace can be bought or changed. FYI: deer season and Open Enrollment often overlap in NC. So go get some venison and some health insurance.

Out-of-Pocket Expenses (n.): Money that you pay for your medical bills, even when you have a health insurance policy. Out-of-pocket expenses include copayments, coinsurance, deductibles, and the cost of anything not covered by the policy, like certain prescription drugs or types of health providers.

Patient Protection and Affordable Care Act (n.): A U.S. law that regulates the health insurance industry. It says that health insurance companies have to cover specific services in all plans and gives price ranges for some plans. It is also referred to as the ACA, the Affordable Care Act, Obamacare, and health care reform.

Premium (n.): The price of a health insurance policy. Not to be confused with the word that means “really really awesome.”

Principal (n.): The amount of a loan that you haven’t paid back yet.

Roth IRA (n.): A kind of Individual Retirement Account that allows you to save up to a particular amount each year. The difference between a Roth IRA and a regular one is that you put in (or “contribute,” as they say) money that’s already been taxed by the government. On the other hand, earnings on a Roth IRA and withdrawals from it made after the age of 59½ are tax-free, so that’s a big win.

401K (n.): A kind of investment available to you at work to help you save for retirement. You can contribute part of your salary automatically to a 401K, if you want. Sometimes employers will contribute to your plan, too.

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