Understanding & Getting Health Care Coverage
A health condition such as asthma, diabetes, or cancer, that you had before the date that your new health care coverage starts.
What is a pre-existing condition
General term for type of health insurance offered by an employer, union, or association to its members.
What is a Group Health Plan?
The Marketplace generally considers this to be you, your spouse if you are married, and your tax dependents.
What is Household?
Health insurance sold by private insurance companies to fill the "gaps" with Traditional Medicare coverage.
What is a Medigap policy?
Refers to use of a health care provider that has a contract with your health insurance plan to provide health care services to its plan members at pre-negotiated rates.
What is "In Network"?
The annual period when individuals can obtain, renew, change, or cancel their health care coverage.
What is Open Enrollment?
The term for an amount that you must pay before your insurance will pay for covered, non-preventive care services.
What is "deductible"?
Kentucky's online Marketplace through which you can purchase individual or family health insurance.
What is kynect?
Free health insurance for children younger than age 19 whose household incomes are less than 218% of the federal poverty level.
What is the Kentucky Children's Health Insurance Program (KCHIP)?
A fixed amount you may be required to pay for office visits, pharmacy, emergency room, outpatient, or suregery visits prior to or after meeting your deductible.
What is a Copay?
The comprehensive health care reform law enacted in March 2010 to make insurance available to more people and define certain mandatory benefits.
What is the Affordable Care Act (ACA)?
A pre-tax savings account for medical expenses which is only available with high-deductible health plans. These accounts can earn interest and remain with the employee following loss of or change in employment.
What is a Health Savings Account (HSA)?
Use age, location, tobacco use, and family size, but not health status, to set premium rates. They must follow ACA guidelines with respect to cost and coverage.
What are Qualified Health Plans?
Insurance program that provides free or low-cost health care coverage to qualified persons with low incomes, including children, pregnant persons, older people, and people with disabilities.
What is Medicaid?
The negotiated amount that providers agree to be paid for a covered health care service. May also be called "negotiated rate."
What is Allowed Amount?
A formal order from your primary care provider for you to see a specialist.
What is a Referral?
A pre-tax account for eligible health expenses, but funds must usually be used within the year, commonly known as "use it or lose it."
What is a Flexible Spending Account (FSA)?
A discount for Marketplace plans that lowers the amount you must pay for deductibles, co-pays, and co-insurance.
What are Cost Sharing Reductions?
This is the federal insurance program for people how are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.
What is Medicare?
The amount paid per month for an insurance policy?
What is a Premium?
A snapshot of a health plan's costs, benefits, covered health care services, and other important detals about the plan.
What is a Summary of Benefits and Coverage (SBC)?
The most you can be required to pay in a given plan year for covered health care services.
What is the Maximum Out-of-Pocket (MOOP)?
An income-based discount for Marketplace plan premiums.
What are subsides or premium tax credits?
Administered by private carriers, this is an alternative to Medicare Parts A, B, and sometimes D.
What is Medicare Part C or Medicare Advantage?
A percentage amount of the allowed cost of your medical care that you are required to pay.
What is Co-insurance?