Key insurance terms that start with "I"

A process to resolve disputes between patients and health plans or providers about coverage decisions or billing. An independent arbitrator reviews the case and makes a binding decision. This process protects patients from denied claims and surprise bills.

The process your insurance company or the government uses to confirm your income to determine your eligibility for subsidies. You may need to provide pay stubs, tax returns, or other income documents. If your actual income differs from what you reported, your subsidies may be adjusted.

A penalty you had to pay if you didn't have health insurance coverage under the ACA's individual mandate. The penalty was calculated as a percentage of income or a flat amount per person, whichever was higher. The penalty was reduced to zero starting in 2019.

A provision of the Affordable Care Act that required most Americans to have health insurance or pay a penalty. The individual mandate penalty was reduced to zero in 2019, so there is currently no penalty for being uninsured, but the requirement technically still exists in some states.

Health insurance coverage for one person only, rather than a family or group. Individual health insurance can be purchased on the health insurance marketplace or directly from insurance companies. Individual plans typically cost more than employer-sponsored group plans.

A fixed amount you pay for a service from an in-network provider. In-network copayments are typically lower than out-of-network copayments. For example, you might have a $20 in-network copay for a doctor visit and a $50 out-of-network copay for the same visit.

The percentage of costs you pay for services from in-network providers after you meet your deductible. For example, if your in-network coinsurance is 20%, you pay 20% and your plan pays 80%. In-network coinsurance is typically lower than out-of-network coinsurance.

Doctors, hospitals, and other providers that have agreed to accept your insurance plan's payment rates. Using in-network providers typically costs less than using out-of-network providers because you pay lower copays and coinsurance. You can find your plan's network in the plan's provider directory.