Glossary

Your Health Idaho has put together a comprehensive glossary to help you understand health insurance language, terms and acronyms.

  • Accountable Care Organization (ACO)

    A group of health care providers who give coordinated care, chronic disease management, and thereby improve the quality of care patients get. The organization’s payment is tied to achieving health care quality goals and outcomes that result in cost savings.

  • Actuarial Value

    The percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70%, on average, you would be responsible for 30% of the costs of all covered benefits. However, you could be responsible for a higher or lower percentage of the total costs of covered services for the year, depending on your actual health care needs and the terms of your insurance policy.

  • Advance Premium Tax Credit (APTC), or Tax Credits

    Advanced Payments of Premium Tax Credit, also known as Tax Credits

    Advance Payments of the Premium Tax Credit lowers the cost of your monthly premium for insurance plans sold on Your Health Idaho. Individuals qualify for a tax credit based on income level and household size. Your Health Idaho works with the Idaho Department of Health and Welfare to determine tax credit eligibility.

    If you qualify, you may choose how much of your allotted tax credit to apply to your premiums each month, up to the maximum amount.

    If you received less Tax Credit than you were eligible for, you will get the difference applied to your tax return.

    If you received more Tax Credit than you were eligible for, you may need to pay the difference back on your tax return.

  • Affordable Care Act

    The federal health care reform law enacted in March 2010. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name “Affordable Care Act” is used to refer to the final, amended version of the law.

  • Agent (also known as a Broker)

    An agent or broker is a person or business who can help you apply coverage and enroll you in a Qualified Health Plan (QHP) through the Your Health Idaho Insurance Marketplace. They can make specific recommendations about which plan you should enroll in. They’re also licensed and regulated by the State of Idaho and typically get payments, or commissions, from health insurers for enrolling a consumer into an issuer’s plans. Some agents and brokers may only be able to sell plans from specific health insurers.

  • Alimony

    Alimony is money you get from a spouse with whom you no longer live, or a former spouse, if paid to you as part of a divorce agreement, separation agreement, or court order. Payments designated in the agreement or order as child support or as a non-taxable property settlement aren’t alimony.

  • Allowed Amount

    Maximum amount on which payment is based for covered health care services. This may be called “eligible expense,” “payment allowance” or “negotiated rate.” If your provider charges more than the allowed amount, you may have to pay the difference.

  • Ambulatory Patient Services

    Medical care provided without need of admission to a health care facility. This includes a range of medical procedures and treatments such as such as blood tests, X-rays, vaccinations, nebulizing and even monthly well-baby checkups by pediatricians.

  • Annual Deductible Combined

    Usually in Health Savings Account (HSA) eligible plans, the total amount that family members on a plan must pay out-of-pocket for health care or prescription drugs before the health plan begins to pay.

  • Annual Household Income

    The total income for a family in a calendar year.

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