Premium

The monthly cost of an insurance plan

Deductible

The amount you pay for covered services before your insurance plan starts to pay. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services.

Maximum Out of Pocket (MOOP)

The most you have to pay for covered services per year. What you pay in deductibles, copays and coinsurance for in-network services all go toward meeting the MOOP. Premiums and payments maid for non-covered services do not apply to the MOOP.

Copay

A fixed amount you pay for covered services after meeting your deductible. For example, you may pay a $40 copay when you see your doctor.

Coinsurance

A percentage of the cost of a service you pay after meeting your deductible. For example, you may pay 20% for the cost of a procedure or test.

Advance Premium Tax Credit (APTC)

A premium tax credit that you can take in advance, in the form of a monthly reduction in your insurance plan payment. When applying for the APTC, the amount you receive will be based on your expected income for the year. The Idaho Department of Health and Welfare (DHW) determines this amount.

Cost Sharing Reduction (CSR)

A discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. It is sometimes called “extra savings.” When you apply for the APTC, Idaho’s DHW determines whether or not you will qualify for CSR. If you do qualify, you must enroll in a Silver level plan to get the extra savings.

Bronze Plans

Lowest cost plans with the highest deductibles. Typically, the less you pay per month, the higher your deductible will be.

Silver Plans

Moderately priced plans with moderate deductibles. Silver level plans are available with reduced deductibles and copays if you qualify for “cost sharing reductions”.

Gold Plan

Gold plans have the lowest deductibles and the highest monthly premiums.

Open Enrollment Period (OEP)

November 1st to December 15th each year
During this six week period a person can enroll in a health insurance plan and the coverage will begin January 1st.

Special Enrollment Period (SEP)

A period of time, outside of the Open Enrollment Period, that you can sign up for health insurance. SEP’s are available if you have a Qualifying Life Event.

Qualifying Life Event

A change in your situation that can make you eligible for a special enrollment period.

Common examples are:
-Losing health coverage
-Moving to another state
-Getting married or having a baby

Network

The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services. Some plans do not pay anything for out-of-network services while others will pay some. You will always pay less when using in-network providers and facilities.

Medicaid

An insurance program that provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities.

Medicare

A federal health insurance program for people 65 and older and certain younger people with disabilities. It also covers people with End-Stage Renal Disease.