Healthcare Reform – Glossary: Key Terms Explained
The new healthcare reform law, also known as the Affordable Care Act, brings with it some terms that may be unfamiliar. Not to worry – we’re here to help decode the jargon.
Our tax experts have put together a handy glossary of the most common terms surrounding the Affordable Care Act. Read through to find out what these phrases mean and how they’ll affect you.
- Adjusted Gross Income (AGI) – Your gross income minus specific adjustments to income. Your AGI directly influences if you’re eligible to claim many tax deductions and credits available.
- Affordable Care Act (ACA) – The healthcare reform law that expands access to health coverage for all Americans and introduces new protections for people who already have health insurance.
- Co-insurance – The percentage you pay to cover medical expenses after your deductible has been met.
- Co-payment – A fixed amount you pay for covered healthcare services at the time medical service is provided. This amount can change based on the type of service and your health insurance plan.
- Deductible – The amount you owe for healthcare costs up to a certain dollar amount. After you’ve paid the deductible, your health insurance plan begins to pay for your healthcare services.
- Department of Health and Human Services (DHHS) – The government agency responsible for protecting the health of all Americans. The DHHS is in charge of implementing some parts of the Affordable Care Act that relate to health insurance.
- Essential Health Benefits – The minimum set of core benefits health insurance plans must provide under the Affordable Care Act. This includes things like emergency services, maternity and newborn care, and prescription drugs.
- Federal Poverty Level (FPL) – An income level measure issued by the Department of Health and Human Services. FPL is used to determine eligibility for certain programs and benefits and will be used to determine eligibility for health insurance through the Affordable Care Act.
- Health Insurance Marketplace – Starting in October 2013, Health Insurance Marketplaces will open. These marketplaces are designed to help you find health insurance that fits your family needs and budget.
- Household Income – Often used as an economic indicator, household income refers to total income from all people living in a household.
- Minimum Essential Coverage – Under the Affordable Care Act, most individuals will be required to maintain this type of health insurance coverage. Government-sponsored programs (like Medicare and Medicaid), employer-sponsored plans, individual market plans, grandfathered health plans and some other types of health coverage already qualify as minimum essential coverage. If you do not have minimum essential coverage in 2014, you may have to pay a tax penalty.
- Out-of-Pocket Costs – Any expenses for medical care that aren’t paid for by your insurance plan.
- Premium – The amount paid for your health insurance for a set time period (like monthly payments or annual payments).
- Premium Assistance Credit – This is a refundable tax credit available to help people purchase health insurance, who can’t afford it. People or families with household incomes of up to 400% of the federal poverty level (about $40,000 for an individual and $89,000 for a family of four in 2011), who do not qualify for other health coverage may be eligible for this credit.
- Qualified Health Plan – A health insurance plan that provides essential health benefits and follows established limits on cost-sharing (like deductibles and co-payments). Under the Affordable Care Act, qualified health plans will be certified by the exchange through which they are sold.
- Subsidy – The amount that the government contributes to help pay for your health insurance. Under the Affordable Care Act, this subsidy, also know as the premium assistance credit, will help people who can’t afford it pay for health insurance. If you qualify for a subsidy, it will go directly to your health insurance provider when you purchase insurance to lower your monthly payments or premiums.
- Tax Credit – A dollar-for-dollar reduction of the income tax you owe. Credits are usually designed to encourage or reward certain types of behavior that the government considers to be good for the economy or the environment.
- Tax Deduction – Tax deductions are expenses that reduce the amount of your income that can be taxed. This can include things like medical expenses that aren’t covered by insurance.
- Tax Penalty – Under the Affordable Care Act, anyone who is not enrolled in a health insurance program by January 1, 2014 will receive a tax penalty, except for those who are exempt. There is no penalty for a single gap in coverage of less than 3 months.
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