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We Asked 15 People To Define These Health Insurance Terms

There's a lot you may not know — like the fact you have to report your health insurance status on your 2014 taxes this year. Get smart about health insurance, and make sure you're prepared by visiting

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1. 1095-A (n.) — "A really good SAT score, probably."


What it actually means: If you got insurance via the Marketplace in 2014, you'll get Form 1095-A: a statement that will help you report your coverage on your tax return.

3. com·mu·ni·ty rat·ing (n.) — "A scale of one to five stars that tells you what your neighbors think of you."

Tyler Sorensen / BuzzFeed

What it actually means: A rule that prohibits health insurance providers from charging different rates within a region based on age, gender, or health status.

4. de·duct·i·ble (n.) — "An item you're willing to remove from your shopping cart."

Tyler Sorensen / BuzzFeed

What it actually means: The amount you have to pay yourself before your health insurance begins to pay. The deductible only counts toward covered health services.

5. es·sen·tial health ben·e·fits (n.) — "What you get from using daily skin moisturizers."

Professional Makeup Tutorials (CC BY http://3.0) / Via

What it actually means: A set of health services all insurance policies must cover, including hospitalization, prescriptions, maternity care, rehabilitation, and others.

6. ex·change (v.) — "When clothing I bought doesn't fit."

Keith (CC BY-SA http://2.0) / Via Flickr: outofideas

What it actually means: Another word for the Health Insurance Marketplace, a resource where people can view and compare plans and enroll in coverage.

7. ex·emp·tions (n.) — "Excuses you used to get out of gym class in high school."

Peter Dutton (CC BY http://2.0) / Via Flickr: joeshlabotnik

What it actually means: A reason for not having health coverage. The ACA requires a penalty on your 2014 taxes if you're uninsured, but there are exceptions.

9. med·i·cal un·der·wri·ting (v.) — "The language doctors use when writing prescriptions."

Grigorij Rasputin (CC0) / Via

What it actually means: The process of determining your health status — used by insurance providers to decide if they should offer you coverage, and at what cost.

10. met·al tiers (n.) — "The ascending layers of a heavy metal cake."

Linda Marklund (CC BY http://2.0) / Via Flickr: 51226001@N03

What it actually means: The health plan categories in the Marketplace — Bronze, Silver, Gold, and Platinum. Each plan dictates the amount you'll spend annually.

11. net·work (n.) — "Wi-Fi."


What it actually means: The physicians, hospitals, and health care providers you can use at pre-negotiated rates — as determined by your insurance company.

12. out-of-pock·et (a.) — "When you forget your gloves and are still willing to get frostbite so you can play on your phone."


What it actually means: The medical expenses you pay for yourself, like co-pays and annual deductibles. The costs that aren't reimbursed by your insurance.

13. pen·al·ty (n.) — "Something that happens in soccer, I think?"

pdnguyen3 (CC BY http://3.0) / Via

What it actually means: If you don't have health insurance after February 15, 2015, you'll have to pay a penalty fee on your tax return, barring possible exemptions.

14. qual·i·fied health plan (n.) — "When your health plan makes the quarter finals."


What it actually means: "An insurance plan that is certified by the Health Insurance Marketplace, provides essential health benefits, and meets other requirements."

15. sub·si·dy (n.) — "An underground city."

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What it actually means: A premium tax credit from the government for low- to middle-income families and individuals — used to help pay for health insurance.

Are you covered for 2015? Brush up on your health insurance terms and get personalized info at

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