Deductible: The amount you pay for covered services before the plan begins to pay.
Out-of-pocket maximum: The most you will have to pay for covered services in a year, no matter how much care you need. covered services in a year, no matter how much care you need. Once you pay this amount for covered services in a year, your plan pays 100% of your services.
Copayments: This is the amount you pay for a covered service after you meet the deductible.
Coinsurance: The percentage of the cost you pay for a covered service after you meet your deductible. your deductible is met.
Health Insurance Marketplace: The Health Insurance Marketplace is a platform that brings together all health plan offerings from private insurers. It provides insurance agents with the facility to consult all health coverage options available to individuals, families and companies.
Insurance agent and broker: A trained insurance professional who can help you enroll in a health insurance plan. Agents may work for only one health insurance company; brokers may represent several companies. You will pay nothing extra if you enroll with an agent or broker.
Agents and brokers must be licensed in their states and have signed agreements to sell Marketplace health plans. In many states, intermediaries are required to act in the best interest of the consumer.
Agents and brokers often receive payments ("commissions") from insurance companies for selling plans. Some may not sell plans from companies they do not represent.
You may qualify for a premium tax credit and other savings if you enroll with an agent or broker. But to get the savings, the agent or broker must enroll you through the Health Insurance Marketplace.
Qualified Health Plan: An insurance plan that is certified by the Health Insurance Marketplace, provides essential health benefits, follows established cost-sharing limits (such as deductibles, copayments, and out-of-pocket maximums), and meets other requirements under the Affordable Care Act. All qualified health plans meet the Affordable Care Act's requirement for health coverage, known as "minimum essential coverage".
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