Table of Contents +
We know health insurance can be confusing – some would even say overwhelming. That’s why we launched HeyHealthInsurance.com in 2023.
We created the site as a resource with a list of frequently used terms and acronyms you may hear or read in connection with health insurance or health care, but about which you may not have a clear understanding.
Our HeyHealthInsurance.com list is ever evolving, like health care and health insurance. For 2025, we’re calling attention to some specific terms and acronyms being added or revised.
If you’re not familiar or certain about a definition, we encourage you to come back in the future to see what’s new.
Entries in our HeyHealthInsurance.com Library include a definition, related terms, and links to other information, and resources – including videos in many cases.
2025 Trending Health Insurance Terms
Some of the “new” terms below are actually updated definitions for existing entries. So, as we noted before, we encourage to check back often to see what else we’ve revised on our site.
ACA Health Insurance
ACA-compliant Health Insurance
ACA Health Insurance is shorthand for Affordable Care Act-compliant Health Insurance, which refers to an individual or group health insurance policy that meets the stringent coverage requirements of the Affordable Care Act (ACA).
According to the U.S. Department of Health and Human Services, the three goals of the ACA when enacted in March 2010 were:
- to make affordable health insurance available to more Americans (this is done through premium tax credits that reduce the cost for low-income households).
- to expand the federal Medicare program to cover all adults with incomes below 138% of the Federal Poverty Level (FPL), and,
- to support innovative medical care delivery methods designed to reduce the cost of health care, generally.
Originally, the ACA had two mandates: one for individuals to have ACA-compliant health coverage (or pay a fine); and another for employers that requires Applicable Large Employers (ALEs) to offer minimum essential coverage that is “affordable” and that provides minimum value to full-time employees (and their dependents). ALEs are also required to report annually on their offer (or failure to offer) minimum essential coverage.
The ACA individual mandate was essentially repealed when the penalty for not having ACA-compliant coverage was reduced to zero dollars at the end of 2018.
Most employers fall below the 50-employee threshold and are not subject to the employer mandate (also known as the shared responsibility provision).
According to the Internal Revenue Service, to be an ALE an employer must have at least 50 full-time employees, including full-time equivalent employees, on average during the prior year.
To determine its workforce size for a year, an employer adds its total number of full-time employees for each month of the prior calendar year to the total number of full-time equivalent employees for each calendar month of the prior calendar year and divides that total number by 12. A full-time employee calculator is available on the HealthCare.gov website.
Individual and Family Plan (IFP), ACA-compliant insurance is available in a variety of ways: directly through an online source such as the Health Insurance Marketplace, with assistance from a broker, or directly through an insurance company. Similarly, employers looking for group health insurance can contact a carrier directly, work through a broker or benefits consultant, or (depending on their group size) purchase coverage through the Health Insurance Marketplace. See our listings for Health Insurance Marketplace and Private Health Insurance Exchange for additional information.
Deductible
Your deductible is a fixed dollar amount (for example, $500), which you must pay for health care service before your health insurance plan begins to pay.
If your deductible is $500, your plan will not pay anything until you have met your $500 deductible for covered health services subject to the deductible. The deductible may not apply to all services covered under your health plan.
Deductible FAQs
What’s a good deductible for health insurance?
That depends on your own individual or family needs and budget. As a general rule the higher your deductible, the lower your health insurance premium. In contrast, the lower your deductible, the higher your plan premium. Your coverage selection (plan type and ACA Metal Tier) also impacts your deductible. Some HMO plans do not have a deductible, while others do. What you need to consider is your likelihood to need care, your budget, and to which services a deductible applies.
Ozempic®
Ozempic is one of several injection anti-obesity medications available to treat type-2 diabetes. It also is prescribed to reduce the risks of cardiovascular events such as stroke, heart attack, or death in adults who have heart disease. Related semaglutide and GLP-1 receptor agonist medications include Mounjaro, Trulicity, Victoza, and Jardiance, which vary and are sometimes used for other health conditions.
Noro Nordisk, the manufacturer of Ozempic, and many other medication manufacturers offer copay cards to reduce the out-of-pocket costs to patients. Eligibility and other restrictions apply. Contact your physician’s office to learn more.
QLE
Qualifying Life Event
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 in health insurance outside of your annual Open Enrollment Period (OEP).
QLE FAQs
Can you cancel your health insurance at any time?
In most situations, yes. However, in some states, there may be a health insurance mandate. For example, in California, Massachusetts, New Jersey, Rhode Island, Vermont, and the District of Columbia, residents are required to have qualifying health insurance coverage or face a tax penalty. You may want to investigate your potential penalty if you drop existing coverage. To learn more about the California Minimum Essential Coverage Individual Mandate, visit the State of California Franchise Tax Board web page.
More to Come
This concludes our latest list of additions to our essential health insurance terms that you, your employees, and your dependents should know. If you have questions about health insurance throughout year, check back at HeyHealthInsurance.com or ask your health insurance or employee benefits broker for assistance.
