Key insurance terms that start with "A"

An automatic process where your insurance plan renews your coverage for the next year unless you make a different choice. If your plan is no longer available, you're automatically enrolled in a similar plan. You can change your plan during Open Enrollment.

The annual process where your insurance company or the government reviews your information to make sure you still qualify for your current coverage and subsidies. You're notified if your eligibility changes and given a chance to update your information. Your coverage continues while redetermination is in progress.

A resource available through the federal government to help resolve disputes between patients and health plans about coverage decisions or billing. The Advanced Resolution Center handles independent dispute resolution for certain medical and prescription drug disputes.

Someone you give permission to handle your insurance matters, like a family member, friend, or advocate. They can enroll you in a plan, ask questions, file appeals, and make changes to your coverage—but only if you formally authorize them in writing.

A formal request to your insurance company to review a decision they made about your coverage. If your claim was denied or you disagree with how much they'll pay, you can file an appeal. You have the right to submit evidence (like a doctor's letter) to support your case.

A cap on how much your insurance will cover for certain health services in a 12-month period. Once you hit the limit, you pay 100% out of your own pocket. The ACA limits what services can have annual limits, so most covered services cannot have limits anymore.

The maximum amount your insurance company will pay for a specific medical service or procedure. This is sometimes less than what your doctor charges. You're responsible for paying any difference between the allowed amount and what your doctor actually charges, unless you have a contract with your insurance.

A licensed professional who helps you find and enroll in health insurance plans. They can explain your options, help you compare coverage, and guide you through the application process. Using an agent is free—the insurance companies pay their commission.

The 2010 federal health law that created the Health Insurance Marketplace, expanded Medicaid, and made it easier for people to buy coverage regardless of health conditions. It's sometimes called Obamacare. The law includes key protections like covering essential health benefits and preventing denials for pre-existing conditions.

Money that helps lower your monthly insurance premiums. The IRS sends it directly to your insurance company so your payments are smaller every month. You receive it in advance of your taxes, which is why it's called 'advance.' It's based on your income and family size.

A measure of how much of your medical costs a health plan is expected to cover. If a plan has 80% actuarial value, the insurance company pays roughly 80% of your covered health costs, and you pay about 20%. It's a way to compare how much financial protection different plans offer.