Key insurance terms that start with "S"

An unexpectedly large bill from a health care provider that you thought would be covered. Surprise bills often happen when you use an in-network facility but get care from an out-of-network doctor without knowing it. The No Surprises Act limits surprise bills for emergency care.

The second-cheapest Silver plan available in your area through the Marketplace. Your Premium Tax Credit is based on the cost of the SLCSP, even if you choose a different plan. This benchmark plan determines how much subsidy you're eligible for each year.

A situation where a small increase in income causes you to lose eligibility for subsidies or causes your subsidies to drop dramatically. The subsidy cliff can create a disincentive to earn more income. The 2021 American Rescue Plan temporarily reduced the subsidy cliff, but it may return in 2026.

Extra insurance coverage that supplements your main health insurance policy. Examples include dental, vision, accident, or critical illness insurance. Supplemental plans cover services that your main plan doesn't include or offer better coverage for specific services.

A standardized one-page document that explains what your health insurance plan covers and what you pay. Every health plan must provide an SBC before you enroll. It shows deductibles, copays, coinsurance, and whether services like ER visits, preventive care, and prescriptions are covered.

Government financial assistance that lowers your health insurance costs. Subsidies include Premium Tax Credits (which lower your monthly premium) and Cost-Sharing Reductions (which lower your deductibles and copays). You may qualify for subsidies based on your income.

A health insurance marketplace run by a state government instead of the federal government. About a dozen states operate their own marketplaces. Rules, plans available, and enrollment periods may differ slightly from the federal Marketplace at healthcare.gov.

A doctor who focuses on a specific area of medicine, like cardiology, dermatology, or orthopedics. To see a specialist, you may need a referral from your primary care doctor (depending on your plan type). Specialists usually charge more than primary care doctors.

A time period outside of Open Enrollment when you can enroll in health insurance or change plans due to a Qualifying Life Event. Examples include losing job-based coverage, getting married, having a baby, or moving. You usually have 60 days from the event to enroll.

Medical and nursing care provided by licensed nurses in a hospital or nursing home. Skilled nursing is usually short-term, following hospitalization or injury. Insurance typically covers skilled nursing if medically necessary and prescribed by a doctor, usually for up to 100 days per benefit year.

A health insurance plan that covers about 70% of your health costs, with you paying roughly 30%. Silver plans have moderate premiums and moderate out-of-pocket costs. They're a popular choice, especially for people who qualify for Cost-Sharing Reduction subsidies.

A strategy where states or insurers intentionally increase Silver plan premiums to reduce the number of subsidies paid by the federal government. Since subsidies are tied to Silver plan costs, higher Silver premiums mean larger tax credits for lower-income people. This is a complex policy strategy that's controversial.

Temporary health insurance coverage lasting a few weeks to a few months, designed to bridge gaps in coverage. Short-term plans often have low premiums but limited benefits and may exclude pre-existing conditions. Rules vary significantly by state, so check what's available where you live.

Health insurance for people who work for themselves and don't have an employer plan. Self-employed people can buy individual coverage through the Marketplace and may qualify for subsidies. You can also deduct a portion of your health insurance premiums from your taxes.