A type of healthcare plan that offers cheaper service if you use doctors, hospitals and other providers in-network for your insurance plan. These plans typically require you to receive a referral from your primary care provider to see specialists, making them more flexible than an HMO plan but less flexible than a PPO.
Point of Service (POS) Plan
A health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts. Under the ACA, insurance companies can't refuse to cover treatment for your pre-existing condition or charge you more. Note: Plans that are not compliant with the ACA may still charge more for those with pre-existing conditions.
Preferred provider organizations (PPOs)
A type of health plan that contracts with medical providers to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. Typically PPOs goffer a wider choice of providers than HMOs. Premiums may be similar to or slightly higher than HMOs, and out-of-pocket costs are generally higher and more complicated than those for HMOs. PPOs allow participants to venture out of the provider network at their discretion and do not require a referral from a primary care physician.
The total amount that must be paid in advance in order obtain coverage for a particular level of services. Usually health insurance premiums are billed and paid on a monthly basis.
Premium tax credits (also known as cost-sharing subsidies)
A tax credit you can use to lower your monthly insurance payment, or premium, when you enroll in a plan through the health insurance marketplaces. The tax credit is based on your income estimate and household information provided in your health insurance application. If your estimated income falls between 100% and 400% of the federal poverty level for your household size, you qualify for a premium tax credit.