Key insurance terms that start with "H"

Hospital outpatient care refers to medical services you receive at a hospital without being admitted as an inpatient. You come in for the service and go home the same day. Outpatient hospital care is distinct from inpatient care (overnight admission) and from services provided in a doctor’s office or clinic.

Common hospital outpatient services include:

• Same-day surgical procedures (arthroscopy, cataract surgery, colonoscopy)
• Chemotherapy and radiation therapy
• Imaging and diagnostic tests (MRI, CT scan, ultrasound at hospital facilities)
• Infusion therapy
• Emergency department visits (when you’re treated and released)
• Physical, occupational, and speech therapy
• Mental health and substance use treatment programs

One important financial distinction: hospital outpatient services typically cost significantly more than the same service performed in a physician’s office or independent clinic — even though your insurance covers both. Hospitals charge facility fees on top of physician fees, which can substantially increase your cost-sharing even if the clinical service is identical.

Medical and supportive services for people with terminal illnesses or life-limiting conditions. Hospice focuses on comfort and pain relief rather than curing the illness. Hospice services are typically covered by health insurance and include nursing care, medications, and support for family members.

Health care services provided in your home, such as nursing care, physical therapy, and wound care. Home health care is usually ordered by a doctor and covered by insurance when medically necessary. It allows people to receive care at home rather than in a hospital or nursing facility.

A High-Deductible Health Plan (HDHP) is a health insurance plan with a higher-than-average deductible and lower monthly premium. The IRS sets minimum thresholds each year that a plan must meet to qualify as an HDHP. For 2026, those minimums are a $1,650 deductible for self-only coverage and $3,300 for family coverage.

The main advantage of an HDHP is HSA eligibility. Only people enrolled in an IRS-qualified HDHP can open and contribute to a Health Savings Account (HSA). Since HSA contributions are tax-deductible, grow tax-free, and can be withdrawn tax-free for medical expenses, an HDHP + HSA combination can be a powerful long-term cost management strategy for healthy households.

The tradeoff: you’ll pay more out-of-pocket before your coverage kicks in for most services. Preventive care is still covered at $0 on HDHPs, as required by ACA rules.

HDHPs are available across all metal tiers — Bronze, Silver, Gold, and Platinum. The “HDHP” label indicates HSA compatibility, not the metal tier.

A Health Savings Account (HSA) is a tax-advantaged savings account you can use to pay for qualified medical expenses. To open and contribute to an HSA, you must be enrolled in a High-Deductible Health Plan (HDHP). The money is yours to keep — it rolls over year to year and never expires.

HSAs offer a rare triple tax advantage:

• Contributions are tax-deductible — reducing your taxable income (and potentially your MAGI for subsidy purposes)
• Growth is tax-free — interest and investment gains aren’t taxed
• Withdrawals are tax-free — when used for qualified medical expenses

For 2026, the IRS contribution limits are $4,300 for self-only coverage and $8,550 for family coverage (with an additional $1,000 catch-up for those 55 and older).

HSA funds can be used for deductibles, copays, coinsurance, prescriptions, dental, and vision care. After age 65, withdrawals for non-medical expenses are taxed as ordinary income (but not penalized), making an HSA function like an IRA for retirement savings.

A Health Reimbursement Arrangement (HRA) is an employer-funded account that reimburses you for qualified medical expenses and, in some cases, health insurance premiums. Unlike FSAs and HSAs, HRAs are funded entirely by your employer — you cannot contribute your own money to one.

There are several types of HRAs:

• Traditional HRA: Paired with employer group health coverage; reimburses out-of-pocket costs
• Individual Coverage HRA (ICHRA): Employers fund an account you use to pay premiums on an individual health plan you purchase yourself — including Marketplace plans
• Qualified Small Employer HRA (QSEHRA): Available to small employers (fewer than 50 employees) to reimburse individual health insurance premiums and medical expenses

If your employer offers an ICHRA, it may affect your eligibility for Marketplace subsidies. An ICHRA is considered affordable if the employee’s remaining premium cost (after the HRA contribution) is below a set percentage of household income — similar to the employer affordability test.

Health plan categories — also called metal tiers — are the four main classifications of ACA Marketplace plans: Bronze, Silver, Gold, and Platinum. Each category describes how the cost of covered health care is split between you and your insurer on average.

The categories help you compare plans on a level playing field. Every ACA plan in every category must cover the same 10 Essential Health Benefits. What changes between categories is how much you pay when you use care, not what’s covered.

• Bronze: Plan pays ~60%, you pay ~40%. Lowest premium, highest cost-sharing.
• Silver: Plan pays ~70%, you pay ~30%. Middle ground — and the only tier eligible for Cost-Sharing Reductions.
• Gold: Plan pays ~80%, you pay ~20%. Higher premium, lower cost-sharing.
• Platinum: Plan pays ~90%, you pay ~10%. Highest premium, lowest cost-sharing.

Catastrophic plans exist as a separate, lower-cost option for people under 30 or those with a hardship exemption. They are not part of the four metal tier categories and do not qualify for Premium Tax Credits.

A Health Maintenance Organization (HMO) is a health insurance plan that requires you to use doctors and facilities within its network. You’ll choose a primary care physician (PCP) who coordinates your care — and in most cases, you need a referral from your PCP before you can see a specialist.

HMOs typically have lower premiums and lower out-of-pocket costs than PPOs, which makes them a strong value if your preferred providers are in the network and you don’t need frequent specialist access.

The tradeoff: outside of emergencies, HMOs generally won’t cover out-of-network care at all. If you see a provider outside the network without authorization, you’ll likely pay the full cost yourself.

HMO is a good fit if:

• You want lower monthly premiums
• Your doctors are already in the HMO network
• You’re comfortable with a PCP coordinating your care
• You rarely need to see specialists or out-of-area providers

HMO may not be the right fit if:

• You have established specialists you want to keep
• You travel frequently and need coverage away from home
• You prefer direct access to specialists without a referral

The Health Insurance Marketplace (also called the Exchange) is the official platform where you can shop for, compare, and enroll in ACA-compliant health insurance plans. It’s also where you apply for Premium Tax Credits and Cost-Sharing Reductions based on your household income.

Most states use the federal Marketplace at HealthCare.gov. Some states run their own: California (Covered California), New York (NY State of Health), Florida (Florida Blue), and others. Subsidies are available on both.

You can only enroll through the Marketplace during specific windows:

• Open Enrollment Period (OEP): November 1 – January 15 for 2026 coverage
• Special Enrollment Period (SEP): Within 60 days of a Qualifying Life Event

Plans purchased off-Marketplace (directly from an insurer) are ACA-compliant but do not qualify for subsidies. If you think you may qualify for financial assistance, always enroll through the Marketplace.

Health insurance is a contract between you and an insurance company in which you pay a monthly premium and the insurer agrees to cover a portion of your medical costs. It protects you from high or unexpected health care expenses by sharing the financial risk between you, your insurer, and sometimes your employer.

In the United States, you can get health insurance through several sources:

• Employer-sponsored plans: Offered through your job, with the employer typically paying a portion of the premium
• ACA Marketplace: Individual and family plans available through HealthCare.gov or state exchanges, with income-based subsidies available
• Medicaid: Free or low-cost coverage for qualifying low-income individuals and families
• Medicare: Federal coverage for people 65 and older or with qualifying disabilities
• CHIP: Low-cost coverage for children in families that earn too much for Medicaid

ACA-compliant plans cannot deny coverage based on pre-existing conditions, cannot impose lifetime or annual dollar limits, and must cover the 10 Essential Health Benefits. Not all health coverage products (short-term plans, fixed indemnity plans) meet these standards.

A waiver from the health insurance requirement under the Affordable Care Act if you experience certain hardships, such as homelessness, domestic violence, or serious financial difficulties. If you qualify for a hardship exemption, you are not required to have health insurance and won't pay a penalty for being uninsured.