Make Smart Open Enrollment Decisions: Essential Insurance Terms You Need to Know

With the Healthcare Marketplace open enrollment period coming up, it’s time to start getting educated on health insurance terms so you can choose the best health insurance policy. recently shared a list of the essential health insurance terms with their definitions so you can prepare before you enroll.

Open Enrollment Period

Open enrollment is the period when anyone can select a health insurance policy. It runs from November 1 through January 15 annually. While some individuals can enroll throughout the year if they qualify for a special enrollment period, open enrollment does not require a change in life events to purchase a new policy. 

Health Insurance Provider Terms

You may have seen some of these terms and have a good understanding of what they mean, but others may be confusing. But these definitions should help clear the confusion, making you a more informed consumer.

Affordable Care Act

The Affordable Care Act is usually abbreviated as ACA, and it’s the piece of legislation that revolutionized health insurance by establishing the Healthcare Marketplace and subsidizing health insurance premiums for qualifying individuals.

Children’s Health Insurance Program

The Children’s Health Insurance Program, often called CHIP, is a joint federal and state-run organization that helps ensure children have insurance and access to medical care.


Medicare is a federal insurance program for individuals aged 65 and over.


Medicaid is a government insurance program for qualifying individuals with low incomes. provides an extensive list, including more health insurance provider terms, explaining many health insurance plan terms.

Health Insurance Policy Terms

To pick a policy that provides what you need, you must understand what the following terms mean:

  • Coverage Level
  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Short-Term Plans

Different coverage levels require different premiums, so you must evaluate your situation to help you find a balance between premiums and coverage. The higher level of coverage you choose, the higher premiums you’ll be responsible for paying.

Then, you’ll need to evaluate the difference between an HMO and a PPO, so you don’t get stuck in a situation where you don’t have the health insurance coverage you thought you did because the provider isn’t in your network.

Health Insurance Cost Terms

Next, the article explains the nitty gritty of health insurance cost terms. These are some of the essential terms to understand because they concern your money and what you’re responsible for paying.

Coinsurance is your responsibility to pay once you’ve reached your deductible. It’s based on a percentage of the cost of service. A co-payment is similar, but it’s a set price for a service.

For example, you may attend a physical therapy session that costs $200. If your coinsurance is 20%, you’ll be responsible for $40 for that session. If the therapy visit cost $400, you’d have to pay $80. If you have a copayment, you’ll pay the set copayment amount for each session.

Deductibles and out-of-pocket expenses are also related to each other. The deductible for health insurance works just like a deductible for auto insurance. It is the amount you have to pay for medical services before your insurance coverage kicks in. 

Then, you’ll pay your coinsurance until you’ve met your maximum out-of-pocket limit for the year. After that, your insurance provider will cover 100% of the allowed charges.

More Health Insurance Terms ends with a list of miscellaneous health insurance terms. This comprehensive educational report will help consumers make an informed choice regarding their health insurance coverage.

Read’s full report to find out more valuable information: Health Insurance Terms To Know As Open Enrollment Begins.

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