The Affordable Care Act (ACA) is the comprehensive federal health care reform law enacted by the U.S. Congress in 2010. It is also sometimes referred to by its full name, the Patient Protection and Affordable Care Act (PPACA), or –...

A required number of deductibles that must be met by insured family members before the family deductible is met. For example, an insurance company offers a $250 deductible and a two times aggregate deductible. Under this coverage, the family must...

An Essential Community Provider (ECP) is a health care provider that serves predominantly lower-income, medically underserved individuals and families. Criteria for ECPs were developed by the U.S. Department of Health and Human Services (HSS) and the Centers for Medicare and...

Essential Health Benefits (EHBs) refers to 10 categories of services that health insurance plans must cover to be compliant with the Affordable Care Act (ACA). These services include: In addition, plans must also include birth control coverage and breastfeeding coverage....

Habilitation and habilitative services are health care services that help a person keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who isn’t walking or talking at the expected age.  These services may...

Care requiring admission to the hospital as an inpatient and usually with an overnight stay. An overnight stay for observation could be outpatient care. Some care or treatment in a hospital may require a pre-authorization from your health plan.

Multiple meanings. Refers to the annual period (November 1-January 15 – or November 1-January 31 in California) during which individuals can enroll in the federal Marketplace or a state Marketplace health insurance plan, such as those offered through Covered California...

Routine health care covered as part of an insurance contract. Includes check-ups, patient counseling, screenings to prevent illness, disease, and other health-related problems. Under the Affordable Care Act (ACA), most health plans must include coverage for a set of preventive...

A licensed medical physician [a Medical Doctor (M.D.) or Doctor of Osteopathic Medicine (D.O.)] who directly provides or coordinates a range of health care services for patients. Health Maintenance Organizations (HMOs) and some Exclusive Provider Organizations (EPOs) require patients to...

A change in your situation — like getting married or divorced, having a baby, adopting a child, moving, or losing health coverage — that can make you eligible for a Special Enrollment Period. Such a situation allows you to enroll...