Healthcare Glossary



A federal law that may permit you to retain existing coverage if your employment ends, if you lose coverage through your spouse or other qualifying events. You are required to pay 100% of the premium for coverage as well as administrative fees. As an employer, you must comply with COBRA if you have more than 20 full- and part-time employees.


In many health plans, patients must pay a portion of the services they receive. This payment is called “coinsurance” and is usually a small percentage of the service cost after the plan pays benefits. For example, if the plan pays 70% of the cost, the patient pays 30% of the cost. Coinsurance is common in PPO products and less common in HMOs.

Community rating

A provision of the Affordable Care Act that prevents insurers from charging more based on an individual’s demographic characteristics like gender, age, pre-existing conditions or more.

Consumer protections

The Affordable Care Act mandated certain requirements to extend protections to healthcare consumers. These protections include preventing insurers from denying coverage to patients with pre-existing conditions, phasing out lifetime caps on coverage, allowing children to stay on their parents plan up to the age of 26 and mandating coverage on 10 essential health benefits like maternity and mental health coverage. A plan must meet these requirements to be compliant with the ACA, but non-ACA compliant plans may not provide some or all of these protections.

Copayments or “copays”

A flat fee that the patient pays at the time of care. After the patient pays the fee, the plan usually pays 100% of the balance on eligible services. The fee usually ranges between $10 and $40. Copayments are common in HMO products and are often characteristic of PPO plans as well.

Cost sharing

This refers to how health plan costs are shared between employers and employees. Generally, costs are shared in two main ways: premium contributions, generally shared by the employer and employee, and cost sharing at the time of service, such as copayments, coinsurance and deductibles, generally paid by the employee.

Cost-sharing reduction

A discount that lowers the amount you have to pay for deductibles, copayments and coinsurance. If you qualify, you must enroll in a plan in the Silver category to get the extra savings. When you fill out an application through or your state’s marketplace, you’ll find out if you qualify for premium tax credits and extra cost-sharing reductions.

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