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Glossary

Insurance Terms in Plain English

Translations for the Medicare, life insurance, Kynect, ACA, and supplemental coverage terms that most commonly confuse people. Search or filter by topic below.

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A

Accelerated Death BenefitLife: A policy feature that may let the insured access part of the death benefit while living under defined circumstances, such as a qualifying terminal illness. Availability and conditions depend on the policy, and using it generally reduces what beneficiaries receive.
Accidental DeathAncillary: Death resulting from a covered accident as the policy defines it, rather than from illness or natural causes. AD&D policies pay only for losses meeting that definition.
Accidental Death Benefit RiderLife: An optional add-on that may pay an additional benefit if the insured passes away as the result of a covered accident. The exact terms and what counts as a covered accident are defined by the policy.
Accidental InjuryAncillary: A physical injury caused by a sudden, unexpected external event, as defined by the policy. Injuries from illness or from causes the policy excludes generally do not qualify.
Actuarial ValueKynect: A measure of what share of covered costs a plan is expected to pay on average for a standard population. It is the basis for the marketplace metal levels and describes the plan design, not your personal costs.
AD&D (Accidental Death & Dismemberment)Ancillary: Supplemental insurance that pays a benefit for a covered accidental death or certain serious accidental injuries. It does not cover illness, and eligibility and underwriting requirements vary by policy — it is not automatically issued to everyone.Learn about AD&D
Admission BenefitAncillary: A hospital indemnity benefit paid when you are admitted to a hospital for a covered stay, typically as a one-time amount per admission. The amount and any limits are set by the benefit schedule.
Advance Premium Tax Credit (APTC)Kynect: The premium tax credit paid in advance to your insurer each month, lowering what you pay for a marketplace plan. Because it is based on estimated income, it is reconciled on your tax return.
Affordable Care Act (ACA)Kynect: Federal law that created the marketplace system, standardized coverage requirements including essential health benefits, and allowed states to expand Medicaid.
Allowed AmountGeneral: The maximum amount a plan recognizes as payable for a covered service. Your share of the cost is usually calculated from the allowed amount rather than the provider’s original charge.
Ancillary InsuranceAncillary: Coverage that sits alongside your main health plan to address specific needs — such as dental, vision, hospital indemnity, critical illness, or AD&D. Ancillary policies are not a replacement for major medical or Medicare coverage.Explore ancillary benefits
Annual Enrollment Period (AEP)Medicare: October 15 – December 7 each year. The yearly window when Medicare beneficiaries can switch between Original Medicare, Medicare Advantage, and Part D plans, with changes generally starting January 1.Medicare enrollment periods
Annual MaximumAncillary: The most a plan will pay toward covered services in a plan year, common on dental coverage. Once the maximum is reached, further costs that year are generally yours.
Annual Notice of Change (ANOC)Medicare: The notice your Medicare Advantage or Part D plan sends each fall describing what is changing for the coming year — costs, benefits, drug list, or network. It is the document to read before deciding whether to keep your plan.
AssignmentMedicare: When a provider agrees to accept Medicare’s approved amount as full payment for a covered service. Providers who accept assignment cannot bill you more than the applicable Medicare cost sharing.

B

Basic Services (Dental)Ancillary: Mid-level dental work such as fillings and simple extractions. Plans typically cover basic services at a different level than preventive or major services, and a waiting period may apply.
Benchmark Plan (SLCSP)Kynect: The second-lowest-cost Silver plan available to your household, used as the reference point for calculating premium tax credits. It is a calculation benchmark — you are not required to enroll in it.
BeneficiaryLife: The person, people, trust, or organization named to receive a policy’s benefit. Most policies let you name more than one and update your choices over time, and the same concept applies to other insurance policies that pay a benefit.
Beneficiary DesignationLife: The written instruction on file with the insurer naming who receives the benefit and in what shares. Because it governs payment directly, keeping it current after major life changes matters.
Benefit PeriodMedicare: The way Original Medicare measures a hospital or skilled nursing stay for Part A cost-sharing purposes. It begins with admission and ends after you have been out of the facility for a set stretch of time, and a new stay later can start a new benefit period with its own deductible.
Benefit ScheduleAncillary: The list in a policy showing exactly which benefits are payable and in what amounts. On fixed-benefit policies the schedule is the single most important page to read, because it defines what you actually receive.
Bronze PlanKynect: A marketplace metal level with generally lower premiums and higher cost sharing when you use care. It can suit people who want protection from large expenses more than help with routine costs.
Burial InsuranceLife: Another common name for final expense insurance — a smaller life insurance policy often used to help cover funeral and burial costs so loved ones are not left to manage them alone.Learn about final expense

C

Cash BenefitAncillary: A fixed payment many supplemental policies pay directly to the insured after a covered event. Unlike reimbursement of an actual medical bill, the payment is generally not tied to a specific charge, though payment arrangements and policy terms vary.
Cash ValueLife: A feature found in many permanent policies, such as whole life, where part of the policy may build value over time. Depending on the policy, this value can sometimes be accessed while you are living, often reducing the death benefit if used.How cash value works
Catastrophic PlanKynect: A marketplace plan type built around high cost sharing, available only to people who meet specific federal eligibility rules. Unsubsidized premiums are generally lower than traditional metal plans, but premium tax credits generally cannot be applied to a catastrophic plan — so whether it actually costs you less depends on the plans and financial help available to you.
Cause-of-Loss RequirementAncillary: The condition that a benefit is payable only when the loss results from a cause the policy covers — for AD&D, an accident as defined by the policy. This is why AD&D does not pay for illness-related losses.
Centers for Medicare & Medicaid Services (CMS)Medicare: The federal agency that administers Medicare and oversees the federal side of Medicaid and the marketplace. CMS sets the rules private Medicare plans must follow.
Change ReportingKynect: Telling the marketplace or Medicaid agency about changes in income, household, address, or other coverage. Reporting promptly keeps your eligibility and any financial help accurate and helps avoid surprises at tax time.
Chronic Condition Special Needs Plan (C-SNP)Medicare: A type of Medicare Advantage Special Needs Plan built for people with a qualifying chronic condition, with benefits and provider networks oriented around that condition. Eligibility requirements apply.
ClaimGeneral: A request for payment submitted to an insurer after care is received or a covered event occurs. Providers often file claims for you, though some supplemental policies ask the member to submit one.
CoinsuranceGeneral: A percentage of an allowed cost you pay after your deductible is met. For example, a plan may split an eligible expense so the plan pays most of it and you pay the stated percentage — the exact split depends on the plan.
Confinement BenefitAncillary: A hospital indemnity benefit paid for each day of a covered hospital stay, subject to the policy’s daily amount and day limits.
Contact Lens AllowanceAncillary: An amount a vision plan applies toward contact lenses. Many plans structure contacts as an alternative to an eyeglass-lens benefit for the same benefit period, but the exact arrangement varies by plan.
Contestability PeriodLife: A limited window, usually the first couple of years after a policy starts, during which the insurer can review a claim more closely for accuracy of the original application. After this period, that review is generally more limited.
Contingent BeneficiaryLife: A backup beneficiary who receives the benefit if no primary beneficiary is able to. Naming one helps avoid complications if a primary beneficiary passes away first.
Conversion OptionLife: A feature on some term life policies that lets you convert to a permanent policy later, often without new health questions. Whether it is available, and within what timeframe, depends on the specific policy.Compare term and whole life
CopayGeneral: A flat dollar amount paid for a covered service at the time of care, such as a set charge per office visit. Copay amounts are listed in the plan’s benefit summary.
Cost-Sharing Reductions (CSRs)Kynect: Extra savings that lower deductibles, copays, and out-of-pocket maximums for eligible households — available only when enrolled in a Silver marketplace plan. Eligibility is based on income and household size.
Covered BenefitAncillary: A service or event the policy actually pays for, as described in the policy documents. Anything not listed as covered — or listed as excluded — is generally not payable.
Covered ConditionAncillary: A specific illness or diagnosis a critical illness policy names as eligible for a benefit. Only listed conditions qualify, and each policy defines its own list and diagnostic requirements.
Covered LossAncillary: A loss that meets the policy’s definition for payment — on an AD&D policy, typically accidental death or a specific listed injury. The policy’s definitions control whether a benefit is payable.
Creditable Prescription Drug CoverageMedicare: Drug coverage — often from an employer, union, or other qualifying source — that is considered at least as good as standard Medicare Part D. Keeping creditable coverage generally protects you from a Part D late enrollment penalty.
Critical Illness InsuranceAncillary: Supplemental coverage that pays a lump-sum benefit if you are diagnosed with a condition the policy lists as covered. Because the payment is not tied to a specific medical bill, it is generally available for other costs as well — covered conditions, requirements, and terms vary by policy.Learn about critical illness coverage

D

Death BenefitLife: The amount paid to the beneficiary if the insured person passes away while the policy is active. This money is generally intended to help with expenses such as funeral costs, household bills, debts, or income replacement.
DeductibleGeneral: The amount you pay out of pocket for covered services before your plan begins to pay its share. Some benefits may be covered before the deductible is met, depending on the plan.
Dental InsuranceAncillary: Coverage that helps with routine cleanings and exams plus a share of other dental work, usually within an annual maximum and often with coinsurance and waiting periods on larger services. Benefit levels and networks vary by plan.Learn about dental coverage
Dental NetworkAncillary: The dentists contracted with a dental plan, who have agreed to negotiated rates. Seeing an in-network dentist generally lowers what you pay for the same work.
DismembermentAncillary: The loss, or loss of use, of a body part or function as specifically defined by an AD&D policy. What qualifies and what percentage is payable come from the policy’s loss schedule.
Drug TierMedicare: The pricing level a plan assigns a medication on its formulary. Lower tiers usually mean lower cost sharing, and the same drug can sit on different tiers from one plan to another.
Dual Eligible Special Needs Plan (D-SNP)Medicare: A Medicare Advantage Special Needs Plan for people who have both Medicare and Medicaid, designed to coordinate the two programs. Eligibility depends on your Medicaid status, which can change.
Durable Medical Equipment (DME)Medicare: Reusable medical equipment prescribed for use at home, such as walkers, wheelchairs, hospital beds, or oxygen equipment. Coverage rules and supplier requirements apply.

E

Effective DateGeneral: The date coverage actually begins. Care received or events occurring before the effective date are generally not covered.
Eligibility DeterminationKynect: The decision about which programs you qualify for — Medicaid, KCHIP, or a marketplace plan with financial help — based on the information in your application. You can be asked for documentation to support it.
Enrollment PeriodGeneral: A defined window during which you can sign up for coverage or make changes. Medicare, the marketplace, and employer plans each use their own enrollment periods.
EPO (Exclusive Provider Organization)General: A plan type that generally covers care only from providers in its network, except in emergencies, but often does not require a referral to see a specialist.
Essential Health BenefitsKynect: The categories of care ACA-compliant plans must cover, such as hospitalization, prescription drugs, maternity and newborn care, mental health services, and preventive care. Specific covered items still vary by plan.
Evidence of Coverage (EOC)Medicare: The detailed document describing exactly what your Medicare Advantage or Part D plan covers, what you pay, and your rights. It is the authoritative reference when a benefit question comes up.
Excess ChargeMedicare: An additional amount a provider who does not accept Medicare assignment may bill above Medicare’s approved amount, within federal limits. Some Medigap plans help cover these charges.
ExclusionGeneral: A service, condition, or circumstance a policy states it will not cover. Exclusions are listed in the policy documents and vary from one policy to another.
Explanation of Benefits (EOB)General: A statement from your plan showing what was billed, what the plan paid, and what you may owe. An EOB is a summary of how a claim was processed — it is not a bill.
Extra Help (Low-Income Subsidy)Medicare: A federal program that helps people with limited income and resources pay Part D premiums and prescription cost sharing. Eligibility is based on income and resources and is determined by the government, not the plan.

F

Face AmountLife: The base amount of coverage listed on the policy — in other words, the core death benefit the policy is built around before any optional additions are considered.
Federal Poverty Level (FPL)Kynect: An income measure, updated yearly by the federal government, used with household size to determine eligibility for Medicaid and marketplace financial help. Because it changes annually, current figures should be confirmed at application time.
Fee-for-ServiceMedicare: A payment structure in which providers bill for each covered service separately. Original Medicare works this way, which is why it has no network restriction but also no yearly out-of-pocket cap on its own.
Final Expense InsuranceLife: Life insurance often used to help cover funeral, burial, and other end-of-life costs. Coverage amounts are typically smaller and the application process is usually simpler than larger policies.Learn about final expense
Fixed IndemnityAncillary: A policy design that pays predetermined amounts for covered events rather than a percentage of your actual bills. Because payment is based on the schedule and not the charge, fixed indemnity coverage supplements — and does not replace — major medical or Medicare coverage.
Foreign Travel Emergency BenefitMedicare: A benefit on certain Medigap plans that may help with emergency care received outside the United States, subject to the policy’s limits and conditions. Original Medicare generally does not cover care abroad.How Medigap works
Form 1095-AKynect: The tax statement the marketplace sends showing your coverage months, premiums, and any advance premium tax credit paid. You need it to complete the tax form that reconciles your credit.
Form 8962Kynect: The IRS form used to reconcile the premium tax credit — comparing the advance amount paid on your behalf with what your actual income supports. It is filed with your tax return using information from Form 1095-A.
FormularyMedicare: The list of prescription drugs a Part D or Medicare Advantage plan covers, usually organized into tiers. Formularies can change from year to year, so checking yours each fall matters.Learn about Part D
Frames AllowanceAncillary: A set dollar amount a vision plan applies toward eyeglass frames, with any cost above it paid by you. Allowances and how often they renew vary by plan.
Free-Look PeriodLife: A short period after a policy is issued during which you can review it and cancel for a refund of premium paid. The length is set by the policy and state rules.
Frequency LimitationAncillary: A rule limiting how often a benefit is available — such as cleanings within a period, or new frames or lenses only once per defined interval. Limits are set by each plan.

G

General Enrollment PeriodMedicare: January 1 – March 31 each year, for people who did not sign up for Medicare when first eligible and do not qualify for a Special Enrollment Period. Late enrollment penalties may still apply.
Gold PlanKynect: A marketplace metal level with generally higher premiums and lower cost sharing when you use care. It can suit people who expect regular medical use.
Grace PeriodLife: A short window after a missed premium payment during which the policy still stays active, giving you time to make the payment before coverage is affected.
Graded Death BenefitLife: A structure used on some smaller or easier-to-qualify-for policies where the full death benefit is not available for non-accidental death during an early period, paying a reduced amount instead. Whether a policy is graded, and for how long, depends on the policy.
Guaranteed IssueLife: A type of policy that generally does not ask health questions, which can help people who have had trouble qualifying elsewhere. It is not always available, often has smaller coverage amounts and waiting periods, and is not automatically the best or cheapest option — it is one tool among several.
Guaranteed-Issue RightMedicare: Specific situations in which a Medigap insurer must sell you a policy without medical underwriting and cannot charge more because of your health history. These rights are limited to defined circumstances and time windows.

H

Health Insurance MarketplaceKynect: The system where individuals and families compare and enroll in ACA-compliant plans and apply for financial help. In Kentucky, that marketplace is Kynect.Explore Kynect
HMO (Health Maintenance Organization)General: A plan type built around a defined network that generally requires you to use in-network providers except in emergencies, and often asks you to have a primary care provider who coordinates referrals.
Home Health CareMedicare: Skilled care such as nursing or therapy provided in your home when you meet Medicare’s coverage requirements. It is intended for skilled needs rather than ongoing personal or custodial care.
HospiceMedicare: Comfort-focused care for someone certified as terminally ill, emphasizing symptom relief and support for the patient and family rather than curative treatment. Hospice is covered under Part A when eligibility criteria are met.
Hospital Indemnity InsuranceAncillary: Supplemental coverage that pays fixed benefits for a covered hospital admission or stay, based on the policy’s benefit schedule rather than the actual hospital bill. Benefits are commonly paid to the insured, though policy and payment terms vary. It supplements — and does not replace — major medical or Medicare coverage.Learn about hospital indemnity
Household (Tax Household)Kynect: The group of people counted together on your application — generally the tax filer, a spouse filing jointly, and tax dependents. Household composition affects both eligibility and the amount of any financial help.
Household IncomeKynect: The combined countable income of everyone in your tax household, used to determine Medicaid eligibility and marketplace financial help. It is based on projected income for the coverage year, not just last year’s.

I

In-NetworkGeneral: A provider, facility, or pharmacy that has an agreement with your plan. Using in-network providers usually means lower cost sharing for you.
Income ReplacementLife: The idea of choosing a life insurance amount that could help replace some of the income a household would lose if the insured passed away, helping cover ongoing expenses like bills, childcare, or a mortgage.
Income VerificationKynect: The step where the marketplace or Medicaid agency confirms reported income, sometimes requesting documents such as pay stubs or tax records. Responding by the stated deadline protects your coverage and financial help.
Initial Enrollment Period (IEP)Medicare: The seven-month window around your 65th birthday — the three months before, your birthday month, and the three months after — during which you first enroll in Medicare. When you enroll within it affects when coverage starts.Medicare eligibility
InpatientGeneral: Care received after being formally admitted to a hospital or facility. Whether a stay is classified as inpatient can affect how benefits are applied.
Institutional Special Needs Plan (I-SNP)Medicare: A type of Medicare Advantage Special Needs Plan for people who live in, or are expected to live in, a qualifying institutional setting such as a nursing facility. Eligibility requirements apply.
Insurable InterestLife: The requirement that the policyowner would experience a genuine loss — usually financial or personal — if the insured passed away. This is why you generally insure yourself or close family rather than a stranger.
InsuredLife: The person whose life the policy covers. The insured is often also the policyowner, but the two roles can belong to different people.
IRMAA (Income-Related Monthly Adjustment Amount)Medicare: An additional amount higher-income beneficiaries pay for Part B and Part D, determined by the Social Security Administration using tax return information from a prior year. It is assessed by the government, not by a plan.

K

KCHIP (Kentucky Children’s Health Insurance Program)Kynect: Kentucky’s children’s health coverage program for eligible children in households that earn too much for standard Medicaid but still qualify for help. Applications go through Kynect.
Kentucky MedicaidKynect: Kentucky’s joint federal-state program providing health coverage to eligible lower-income residents, with no set enrollment season — you can apply whenever you may qualify. Eligibility is based on income, household, and other rules.Get help with Medicaid
KynectKynect: Kentucky’s state-run benefits platform where residents apply for Medicaid, KCHIP, Qualified Health Plans, and other state benefit programs. It is where Kentucky’s marketplace enrollment happens.Explore Kynect
KynectorKynect: A state-supported assister who can help Kentucky residents complete a Kynect application at no cost. Licensed insurance agents can also help and can additionally give recommendations about specific plans.

L

Late Enrollment PenaltyMedicare: An ongoing amount added to your Part B or Part D premium if you go without required coverage after becoming eligible and had no qualifying exception. Penalties generally continue for as long as you hold that coverage.
Lens BenefitAncillary: The portion of a vision plan covering eyeglass lenses, often with standard lens types covered and upgrades such as coatings or progressives costing extra. Details are set by the plan.
Level TermLife: A common form of term life where the premium and the coverage amount stay the same for the entire term — for example, a 20-year level term keeps both steady for 20 years.Learn about term life
Life InsuranceLife: A policy that pays a sum of money to chosen beneficiaries if the insured person passes away while the coverage is active. It is generally used to help loved ones with expenses like funeral costs, household bills, debts, or replacing lost income.Explore life insurance
Lifetime Reserve DaysMedicare: A limited, once-per-lifetime pool of extra inpatient hospital days Original Medicare covers after a benefit period’s standard days are used, with higher daily cost sharing. Once used, they are not replenished.
LimitationGeneral: A restriction on how much or how often a benefit is available — for example, a cap on visits or a set interval between covered services. Limitations are defined by the individual policy.
Loss ScheduleAncillary: The table in an AD&D policy showing which covered losses pay what share of the principal sum. It is what determines the actual benefit amount for a given loss.
Lump-Sum BenefitAncillary: A single payment made when a policy’s conditions are met, rather than reimbursement spread across bills. Critical illness policies commonly pay this way.

M

Major Services (Dental)Ancillary: Larger dental work such as crowns, bridges, or dentures. Plans usually cover major services at the lowest benefit level and often apply a longer waiting period.
Medicaid ExpansionKynect: The ACA provision allowing states to extend Medicaid to more low-income adults. Kentucky adopted expansion, which is why many working adults without children may qualify.Get help with Medicaid
Medical Exam (Life Insurance)Life: A brief health check some applications require, often including basic measurements and lab work. Whether an exam is needed depends on the policy, the coverage amount, and the insurer’s underwriting rules.
Medical Eye CareAncillary: Care for eye disease, injury, or a medical condition affecting the eyes, which is typically handled by your health plan rather than a routine vision plan. Knowing this split helps avoid surprise billing questions.
MedicareMedicare: The federal health insurance program primarily for people 65 and older, and for some younger people with qualifying disabilities or conditions. It is made up of Part A, Part B, Part C, and Part D.What is Medicare?
Medicare Advantage (Part C)Medicare: Private plans approved by Medicare that deliver your Part A and Part B benefits, usually through a provider network, and often include Part D drug coverage plus extra benefits. These plans have a yearly out-of-pocket maximum.Learn about Medicare Advantage
Medicare Advantage Open Enrollment PeriodMedicare: January 1 – March 31 each year, when someone already enrolled in a Medicare Advantage plan may make one change — switching to another Advantage plan or returning to Original Medicare. It is not a window for people on Original Medicare to join an Advantage plan.
Medicare Advantage Prescription Drug Plan (MA-PD)Medicare: A Medicare Advantage plan that includes Part D prescription coverage in the same plan, rather than requiring a separate drug plan.
Medicare Part AMedicare: The hospital side of Medicare — inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Most people qualify for Part A without a monthly premium based on work history.How Medicare works
Medicare Part BMedicare: The medical side of Medicare — doctor visits, outpatient care, preventive services, lab work, and durable medical equipment. Part B has a monthly premium and its own cost sharing.How Medicare works
Medicare Part DMedicare: Prescription drug coverage, available either as a standalone plan paired with Original Medicare or bundled into a Medicare Advantage plan. Each plan has its own formulary, pharmacy network, and cost sharing.Learn about Part D
Medicare Savings ProgramsMedicare: State-administered programs that help people with limited income and resources pay Medicare costs such as premiums and, in some cases, deductibles and coinsurance. Eligibility is determined by the state.
Medicare Summary Notice (MSN)Medicare: The periodic statement Original Medicare sends listing services billed, what Medicare paid, and what you may owe. It is a summary for your records, not a bill.
Medigap (Medicare Supplement Insurance)Medicare: A policy sold by private insurers that works alongside Original Medicare to help cover certain out-of-pocket costs such as coinsurance and deductibles. Medigap does not include drug coverage, so a separate Part D plan is usually needed.Learn about Medigap
Medigap Open Enrollment PeriodMedicare: A one-time six-month window that starts when you are both 65 or older and enrolled in Part B, during which you can buy any Medigap policy sold in your state without medical underwriting. Outside this window, health questions may apply.Learn about Medigap
Metal LevelKynect: The Bronze, Silver, Gold, and Platinum tiers used to group marketplace plans by how costs are generally split between plan and member. Metal level describes cost sharing, not quality of care.
Minimum Essential CoverageKynect: Qualifying health coverage under ACA rules, such as most employer plans, marketplace plans, Medicaid, and Medicare. An involuntary loss of qualifying coverage can open a Special Enrollment Period, but canceling coverage voluntarily — or losing it only because premiums went unpaid — does not automatically create that same right.
Modified Adjusted Gross Income (MAGI)Kynect: The income measure used to determine Medicaid eligibility and marketplace financial help. It starts from adjusted gross income and adds back certain items, so it can differ from take-home pay.
Mortgage ProtectionLife: Life insurance designed around mortgage-related protection needs, so that a home loan does not become a burden for loved ones if the insured passes away. It is a way of using life insurance for a specific goal — not a separate category of insurance.Learn about mortgage protection

N

Needs AnalysisLife: A simple walkthrough of what your household would actually need if you were gone — debts, income, final expenses, and future goals — used to choose a coverage amount rather than guessing.Find your life insurance path
No-Exam Life InsuranceLife: Policies that can be issued without a medical exam, usually relying on health questions and database checks instead. Approval still depends on the insurer’s review, and coverage amounts may be more limited.

O

Observation StatusMedicare: When a hospital keeps you for monitoring without formally admitting you as an inpatient. It is generally billed as outpatient care, which can change how Medicare benefits and some supplemental policies apply — so it is worth asking about your status during a hospital stay.
Open EnrollmentKynect: The annual window to enroll in or change marketplace coverage through Kynect. Outside it, you generally need a Special Enrollment Period — and it is separate from Medicare’s Annual Enrollment Period.Kynect enrollment periods
Original MedicareMedicare: Part A and Part B together — the federal fee-for-service program you can use with any provider who accepts Medicare. It has no provider network and no yearly out-of-pocket maximum on its own.How Medicare works
Orthodontic BenefitAncillary: Coverage toward braces or similar treatment, when a dental plan includes it at all. Orthodontic benefits often carry a separate lifetime maximum, age rules, and a waiting period.
Out-of-NetworkGeneral: A provider or facility without an agreement with your plan. Depending on the plan, out-of-network care may cost significantly more or may not be covered except in emergencies.
Out-of-Pocket CostGeneral: What you pay yourself for care — including deductibles, copays, and coinsurance. Premiums are usually counted separately from out-of-pocket costs.
Out-of-Pocket Maximum (MOOP)General: The yearly cap on what a member pays out of pocket for covered in-network services. Once the cap is reached, the plan generally covers eligible in-network services for the rest of the plan year. Original Medicare by itself does not have one.
OutpatientGeneral: Care received without being formally admitted as an inpatient — such as an office visit, same-day procedure, or emergency room visit that does not result in admission.

P

Part B Special Enrollment PeriodMedicare: A window to enroll in Part B without a late penalty after certain qualifying situations end, most commonly coverage through current active employment. Specific rules and documentation apply.
Part D Coverage StagesMedicare: The phases a Part D plan moves through during the year as costs accumulate — typically a deductible stage, an initial coverage stage, and then catastrophic coverage, after which covered drug costs are largely handled by the plan. Stage details are set by federal rules and the plan.Learn about Part D
Permanent Life InsuranceLife: Life insurance designed to last for your lifetime as long as premiums are paid, rather than ending after a set number of years. Whole life is a common example, and many permanent policies may build cash value.Term vs whole life
Pharmacy NetworkMedicare: The pharmacies contracted with a drug plan. Filling prescriptions outside the network can cost more or may not be covered at all.
Plan YearKynect: The twelve-month period a plan’s benefits, deductible, and out-of-pocket maximum apply to. For marketplace coverage the plan year generally follows the calendar year.
Platinum PlanKynect: A marketplace metal level with the highest premiums and lowest cost sharing among the standard levels. Availability depends on what insurers offer in your area.
Policy AssignmentLife: Transferring some or all of the policyowner’s rights in a policy to another person or entity. It is a formal change made through the insurer, not an informal arrangement.
Policy LapseLife: When a policy ends because required premiums were not paid within the allowed time. Once a policy lapses, coverage generally stops, though some policies offer ways to reinstate within certain limits.
Policy LoanLife: Borrowing against the cash value of a permanent policy. Loans accrue interest and an unpaid balance generally reduces the death benefit, so terms should be reviewed with the insurer.
PolicyownerLife: The person who owns and controls the life insurance policy. The policyowner manages decisions like naming beneficiaries and paying premiums, and is often — but not always — the same person who is insured.
PPO (Preferred Provider Organization)General: A plan type with both in-network and out-of-network benefits, generally without requiring a referral to see a specialist. Out-of-network care typically costs more.
Pre-Existing ConditionAncillary: A health condition that existed before coverage began. Some supplemental policies limit or exclude benefits related to pre-existing conditions for a defined period, as spelled out in the policy.
Preferred PharmacyMedicare: An in-network pharmacy where a drug plan offers its lowest cost sharing. A pharmacy can be in network but not preferred, which usually means you pay more there.
PremiumGeneral: The recurring amount you pay to keep coverage active, whether or not you use services. Premiums are separate from what you pay when you actually receive care.
Premium (Life Insurance)Life: The amount you pay — monthly or annually — to keep a life insurance policy active. Paying the premium on time is what keeps the coverage in force.
Premium Tax Credit (PTC)Kynect: An income-based tax credit that reduces the cost of marketplace coverage. Eligibility depends on household income, household size, and the cost of the benchmark plan in your area, so it should be checked rather than assumed.
Premium Tax Credit ReconciliationKynect: The tax-time comparison between the advance credit paid on your behalf and what your actual income supports, which can increase or decrease your refund or amount owed. Reporting income changes during the year keeps the gap small.
Preventive ServicesGeneral: Screenings, immunizations, and wellness visits intended to catch problems early. Many plans cover a defined list of preventive services at little or no cost when received in network.
Preventive Services (Dental)Ancillary: Routine dental care such as cleanings, exams, and X-rays. Dental plans commonly cover preventive services at the highest benefit level, often with no waiting period.
Primary BeneficiaryLife: The first person or entity in line to receive the death benefit. If more than one is named, the policy specifies how the benefit is divided.
Primary Care Provider (PCP)General: The clinician who handles your routine care and, on some plans, coordinates referrals to specialists. Certain plan types ask you to select one.
Principal SumAncillary: The base benefit amount an AD&D policy is built around. Accidental death typically pays the full principal sum, while listed injuries pay a percentage of it per the loss schedule.
Prior AuthorizationGeneral: Approval a plan requires before it will cover certain services, procedures, or medications. Which items need approval varies by plan.
Proof of LossAncillary: The documentation an insurer requires to pay a claim — such as records confirming a hospital stay, diagnosis, or accident. Policies set deadlines for submitting it, so filing promptly matters.
Provider NetworkGeneral: The doctors, hospitals, pharmacies, and other providers contracted with a plan. Checking that your providers are in a plan’s network is one of the most important steps before enrolling.

Q

Qualified Health Plan (QHP)Kynect: An ACA-compliant private plan offered through Kynect that covers essential health benefits and can be eligible for financial help based on income.Learn about Qualified Health Plans
Qualified Medicare Beneficiary (QMB)Medicare: A Medicare Savings Program for people with limited income and resources that helps with Medicare premiums and cost sharing. Providers generally may not bill QMB enrollees for Medicare cost sharing on covered services.
Qualifying Individual (QI)Medicare: A Medicare Savings Program that helps pay the Part B premium for people within its income and resource limits. Eligibility is determined by the state.
Qualifying Life Event (QLE)General: A life change — such as losing qualifying coverage, marriage, a birth or adoption, or certain permanent moves — that can open a Special Enrollment Period. Eligibility and documentation rules are specific to each event, so not every change of that kind qualifies.
Quantity LimitMedicare: A cap a drug plan places on how much of a medication it will cover in a given period. Exceptions can sometimes be requested through the plan.

R

Recurrence BenefitAncillary: A feature on some critical illness policies that may allow an additional payment if a covered condition occurs again after a required separation period. Availability and conditions depend entirely on the policy.
Redetermination (Renewal)Kynect: The periodic review confirming you still qualify for Medicaid or marketplace financial help. Missing a renewal notice or request for information is a common way people lose coverage they still qualify for.
ReferralGeneral: A primary care provider’s authorization to see a specialist. Some plan types require one for specialist care to be covered; others do not.
ReinstatementLife: Restoring a lapsed policy under the insurer’s conditions, which often include paying back premiums and answering health questions again. Reinstatement is not guaranteed and time limits usually apply.
Renewable TermLife: A term policy feature allowing coverage to continue past the original term without new health questions, typically at a higher premium that reflects the insured’s age. Availability and limits are set by the policy.
Replacement (Policy Replacement)Life: Ending or changing an existing policy in order to buy a new one. Because a new policy can mean new waiting periods, new contestability, and age-based pricing, replacement deserves a careful side-by-side comparison first.
RiderLife: An optional add-on that adjusts or expands what a policy does. Riders let you tailor coverage to your situation, and the specific options available depend on the policy and insurer.
Routine Eye ExamAncillary: A standard vision exam checking sight and eye health and producing a prescription. Routine exams are the core of a vision plan, separate from medical eye care.
Routine Vision CareAncillary: Everyday vision services — exams, glasses, and contacts — that vision plans are designed around. This is distinct from treatment of eye disease or injury.

S

Silver PlanKynect: A marketplace metal level in the middle on premiums and cost sharing. Silver is also the only level where cost-sharing reductions can apply, which makes it especially important for eligible households.
Simplified IssueLife: A type of policy that uses a shorter application with health questions but typically no medical exam. It can be a faster path to coverage for some people, though approval and terms still depend on the answers and the insurer’s review.
Skilled Nursing Facility (SNF)Medicare: A facility providing skilled nursing or rehabilitation care. Medicare coverage of a stay depends on meeting specific requirements, including a qualifying prior hospital stay in many cases.
Social Security Administration (SSA)Medicare: The federal agency that handles Medicare enrollment, premium withholding from Social Security benefits, and income-related premium adjustments. Plan selection is separate and handled through Medicare or an agent.
Special Enrollment Period (SEP)General: A window outside the normal enrollment season during which you can enroll or change coverage, opened by a qualifying event. The length of the window and the changes allowed depend on the event and the program.
Special Needs Plan (SNP)Medicare: A Medicare Advantage plan limited to people who meet specific eligibility criteria — such as having a qualifying chronic condition, both Medicare and Medicaid, or living in an institutional setting. Benefits are tailored to that group.
Specified Low-Income Medicare Beneficiary (SLMB)Medicare: A Medicare Savings Program that helps pay the Part B premium for people within its income and resource limits. Eligibility is determined by the state.
Standardized Medigap PlansMedicare: Medigap policies are sold as lettered plans whose core benefits are standardized by federal rules, so the same letter covers the same things regardless of insurer. Price, service, and plan availability still differ between companies.Learn about Medigap
Star RatingsMedicare: A quality rating Medicare publishes for Medicare Advantage and Part D plans, covering areas like member experience and customer service. Ratings are one useful input, not a substitute for checking your own doctors, drugs, and costs.
Step TherapyMedicare: A requirement to try a lower-cost medication first before the plan will cover a more expensive alternative. Your prescriber can usually request an exception when medically appropriate.
Suicide ExclusionLife: A standard life insurance provision limiting payment of the death benefit if death results from suicide within an early period after the policy starts, usually returning premiums instead. The exact period is defined by the policy and state law.
Summary of BenefitsMedicare: A shorter overview of what a plan covers and what you pay, useful for comparing plans. The full Evidence of Coverage governs the actual details.
Supplemental InsuranceAncillary: Coverage added on top of primary health or Medicare coverage to help with specific costs or gaps. Supplemental policies work alongside your main coverage rather than replacing it.Common coverage gaps
Surrender ValueLife: The amount the policyowner would receive by canceling a permanent policy and taking its cash value, after any charges or outstanding loans. Surrendering ends the coverage and the death benefit.
Survival PeriodAncillary: A requirement on some critical illness policies that the insured live a specified number of days after diagnosis for the benefit to be payable. Whether one applies, and for how long, depends on the policy.

T

Term Life InsuranceLife: Coverage that lasts for a set period of time — often 10, 20, or 30 years. If the insured passes away during that term while the policy is active, the death benefit is paid. It is usually the most straightforward and affordable type of life insurance.Learn about term life
Termination DateGeneral: The date coverage ends. Knowing it matters when moving between plans so you do not leave an unintended gap.

U

Underwriting (Life Insurance)Life: The process an insurer uses to review an application and decide whether to offer coverage and on what terms. It may consider factors like age and health history. Underwriting does not guarantee approval, and outcomes vary by person and policy.How life insurance works
Underwriting (Medicare)Medicare: An insurer’s review of your health history when you apply. Buying a Medigap policy outside a guaranteed-issue situation or your Medigap open enrollment window may require medical underwriting, and coverage is not guaranteed.

V

Vision InsuranceAncillary: Coverage for routine eye care — exams, lenses, frames, or contacts — usually with set allowances and frequency limits rather than open-ended benefits. Medical eye conditions are generally handled by your health plan.Learn about vision coverage
Vision NetworkAncillary: The optometrists, ophthalmologists, and retailers contracted with a vision plan. In-network providers typically mean better allowances and lower out-of-pocket cost.

W

Waiting PeriodGeneral: A stretch of time after coverage begins before certain benefits become available. Waiting periods are common on some supplemental and smaller life policies and are defined by the policy.
Waiver of Premium RiderLife: An optional add-on that may keep a policy in force without premium payments if the insured meets the policy’s definition of a qualifying disability. Conditions, waiting periods, and availability vary by policy.
Whole Life InsuranceLife: A type of permanent life insurance designed to stay in force for life as long as premiums are paid. In addition to a death benefit, whole life policies may build cash value over time that you can access in certain ways.Learn about whole life

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