Agent / BrokerA person licensed to sell health insurance and help consumers apply for coverage. An independent agent, like Cesar, isn't tied to one insurance company and can compare plans across carriers.Annual Enrollment Period (AEP)Medicare's yearly window (in the fall) when anyone with Medicare can switch Medicare Advantage or Part D plans for the coming year.CoinsuranceYour share of a covered service's cost, expressed as a percentage, that applies after you've met your deductible.Copay (Copayment)A fixed dollar amount you pay for a specific covered service, regardless of the total cost of that service.DeductibleThe amount you pay for covered services before your insurance starts sharing the cost (preventive care is often an exception).Effective DateThe date your coverage actually starts — it's often not the same day you enroll.Essential Health BenefitsThe set of categories every ACA-compliant plan must cover, including hospitalization, prescription drugs, maternity care, mental health services, and preventive care.Explanation of Benefits (EOB)A statement your insurance company sends after a claim is processed, showing what was billed, what the plan paid, and what you may owe. It is not a bill itself.Federal Poverty Level (FPL)A federal income measure, updated annually, used to determine eligibility for subsidies and certain programs. The specific dollar thresholds change every year.FormularyThe list of prescription drugs a health or drug plan covers, usually organized into cost tiers.Generic DrugA medication with the same active ingredient as its brand-name equivalent, typically sold at a lower cost.Grace PeriodA window of time after a missed premium payment during which your coverage can generally continue before it's terminated for non-payment.Guaranteed IssueA rule requiring an insurer to offer coverage regardless of health status, during specific windows or circumstances defined by law.HMO (Health Maintenance Organization)A plan type that generally requires a primary care physician and referrals to see specialists, with little to no out-of-network coverage.In-Network / Out-of-NetworkWhether a provider has a contract with your plan (in-network, lower cost to you) or not (out-of-network, higher cost or not covered).Marketplace / ExchangeThe system created by the ACA where individuals shop for and enroll in private health plans, often with a subsidy.Medicare Part AThe part of Original Medicare that covers inpatient hospital care, skilled nursing facility care, hospice, and some home health care.Medicare Part BThe part of Original Medicare that covers outpatient care, doctor visits, preventive services, and durable medical equipment.Medicare Part C (Medicare Advantage)Medicare benefits delivered through a private insurance company instead of directly through the government — see our full explainer.Medicare Part DMedicare's prescription drug coverage, available as a stand-alone plan (with Original Medicare) or bundled into many Medicare Advantage plans.Medigap (Medicare Supplement)A private policy that pairs with Original Medicare to help cover some of the costs Medicare doesn't pay, like coinsurance and copays.NetworkThe specific group of doctors, hospitals, and pharmacies a plan has contracted with — see our full explainer.Open Enrollment PeriodThe annual window when anyone can enroll in or change a plan without needing a qualifying life event. Dates vary by year and by program (Marketplace vs. Medicare).Out-of-Pocket MaximumThe most you'll pay for covered services in a plan year before your insurance covers 100% of further covered costs.PCP (Primary Care Physician)Your main doctor for routine care, who — on many plans — also coordinates referrals to specialists.PPO (Preferred Provider Organization)A plan type that generally allows seeing specialists without a referral and offers some out-of-network coverage, usually for a higher premium.Pre-Existing ConditionA health condition that existed before your coverage started. Under the ACA, plans cannot deny coverage or charge more because of one.PremiumThe amount you pay, usually monthly, to keep your health insurance active — separate from what you pay when you actually use care.Premium Tax Credit (APTC)The official name for an ACA subsidy — a tax credit, based on income and household size, that lowers your monthly Marketplace premium.Preventive CareA defined list of services — like annual checkups and standard screenings — that most ACA-compliant plans cover with no cost-sharing when done in-network.Prior AuthorizationA requirement that your plan approve certain services or medications before you receive them, or before the plan will cover them.Qualifying Life EventA specific life change — like losing other coverage, marriage, or having a child — that can trigger a Special Enrollment Period.ReferralAuthorization from your primary care physician to see a specialist, generally required on HMO plans.Special Enrollment Period (SEP)A limited-time window to enroll in or change coverage outside of Open Enrollment, triggered by a qualifying life event.Star RatingCMS's annual 1-to-5 star quality rating for Medicare Advantage and Part D plans, based on member experience, outcomes, and service quality.