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Preexisting Condition Prior to 2014, purchasing individual healthcare with a pre-existing condition, an insurer might have declined covering your condition, or they might have denied you coverage altogether. However, now with the ACA, insurers must provide individual...
10 Essential Health Benefits What are “Essential Health Benefits”? If your plan does not cover these services, it is not a “Qualified Health Plan”: ♦ Ambulatory patient services (clinics, doctors office, same-day surgery centers, etc.)♦ Emergency services♦...
Health Insurance Deductible A deductible is an amount you pay before the Insurance Company starts paying. Health insurance plans will have different deductibles. Low deductible examples might be a “Gold” plan, with example deductibles of $500, $1,000, $2000, etc. An...
Federal Poverty Level Everyone has a “federal poverty level” (FPL), even wealthy people. They just have a higher FPL. People that have a “household” income that falls between 138% up to 400% of the FPL (Federal Poverty Level), can get assistance with paying for their...
Cost Sharing Reduction If your family size and income ranks you at under 250% of the Federal Poverty Level, this cost reduction will reduce your total out of pocket responsibilities in overall medical costs. You’ll get additional financial assistance to cover more of...
Prescription Pricing Tiers Medication Pricing Tiers determine the level of coverage your prescription drug plan offers for a specific type of medication. Many prescription drug plans use a 4-tier system, while some insurers have an additional 5th or even 6th. Your...
Copay (copayment) A set dollar amount you pay for a procedure or office visit. (Look at your plan summary very carefully) A copay is helpful because you’ll GENERALLY pay just the copay (unless other procedures are billed by your doctor in addition to the copay). For...
Prescription Deductible The amount of money that you pay out of your pocket before the insurance company begins to pay. A prescription deductible is the portion you’d pay first, then after you’ve paid the deductible, you may only have to pay a copay after that when...
