Eligibility
Subsidy (Tax Credit)
We estimate your eligibility for a subsidy (tax credit) to reduce plan costs. Amounts are estimates — a web broker or licensed agent can help you complete the federal application to learn your official amount.
Health insurance definitions
Plain-language answers to the terms you'll see on Health Plan Radar
Below are definitions for terms across Health Plan Radar. We also build definition pop-ups into the platform — hover over a term and click the question mark for its definition. Search or filter by category to find what you need.
Eligibility
Cost Sharing Reduction (CSR)
CSR plans are Silver plans with lower out-of-pocket costs than normal Silver plans. If you're eligible, watch for these — they may be your most affordable option.
Eligibility
Medicare
A family member over 65 may be eligible for Medicare with premiums as low as $0, and isn't included in the plans shown because Medicare is usually more affordable.
Eligibility
Medicaid / CHIP
Free or low-cost state health insurance for people who meet income requirements. Those who qualify aren't included in the plans shown; visit HealthCare.gov for options.
Costs & pricing
Monthly Premium
The monthly cost of the plan. It doesn't include out-of-pocket costs you pay when getting care (deductibles, copays, coinsurance).
Costs & pricing
Full Cost
The plan's monthly premium before any subsidy is applied.
Costs & pricing
Your Cost
The monthly cost of the plan after applying your subsidy (Full Cost − Subsidy).
Costs & pricing
Subsidy
A tax credit you can apply in advance each month to reduce the monthly premium, instead of waiting until you file taxes.
Costs & pricing
Deductible
You usually pay full cost for care until you reach the deductible; after that you pay based on copays and coinsurance. It resets yearly and premiums don't count toward it. Family plans often have separate individual and family amounts.
Costs & pricing
Max Out-of-Pocket (MOOP)
The most you'll pay for covered out-of-pocket costs in a year. Once reached, you pay nothing more for covered care. Premiums don't count toward it.
Costs & pricing
Min Out-of-Pocket
Always $0 — the case where you need no medical care and spend nothing out of pocket.
Costs & pricing
Annual Premium
The yearly premium cost of the plan (monthly premium × 12).
Costs & pricing
Min Cost
The least you could pay for the plan — paying the premium but needing no medical care.
Costs & pricing
Max Cost
The most you could pay for the plan — the annual premium plus the max out-of-pocket amount.
Costs & pricing
HPR Average Out-of-Pocket
Our estimate of the average out-of-pocket costs members of a plan pay for care. Remember it's an average — needs vary from person to person.
Costs & pricing
Average Total Cost
Our estimate of the average yearly total cost — the annual premium plus HPR Average Out-of-Pocket.
Costs & pricing
HPR Affordability Rank
Our ranking of a plan's affordability versus your other options, based on estimated average total cost (premium + estimated average out-of-pocket).
Costs & pricing
HSA
A Health Savings Account lets you pay medical expenses with tax-free dollars. A plan must have a high deductible to be HSA-eligible.
Metal levels
Metal Level
Classifies plans by how total costs split between premium and out-of-pocket costs, and signals typical premium levels.
Metal levels
Catastrophic
Very low monthly premiums but very high out-of-pocket costs. Subsidies cannot be used for Catastrophic plans.
Metal levels
Bronze
Low monthly premiums but high out-of-pocket costs when you need care.
Metal levels
Silver
Low–medium monthly premiums with medium–high out-of-pocket costs.
Metal levels
Silver CSR
Silver plans with lower out-of-pocket costs than regular Silver plans, for those eligible for Cost Sharing Reduction.
Metal levels
Gold
Medium–high monthly premiums with low–medium out-of-pocket costs.
Metal levels
Platinum
High monthly premiums but low out-of-pocket costs when you need care.
Plan types
Plan Type
Classifies plans by access to doctor and hospital networks and how the plan is administered.
Plan types
EPO
Exclusive Provider Organization — services are covered only if you use in-network doctors, specialists, or hospitals (except in an emergency).
Plan types
HMO
Health Maintenance Organization — usually limits coverage to doctors who work for or contract with the HMO; no out-of-network care except emergencies. May require living or working in the service area.
Plan types
POS
Point of Service — you pay less using in-network providers and need a referral from your primary care doctor to see a specialist.
Plan types
PPO
Preferred Provider Organization — you pay less in-network but can go out-of-network without a referral for an additional cost.
Coverage details
Insurance Company
The company offering the plan. Also called the carrier or issuer.
Coverage details
Plan Name
The name given to the plan by the insurance company offering it.
Coverage details
Drug Deductible
You pay full cost for prescriptions until you reach this amount, then pay based on copays and coinsurance. It may be combined with the medical deductible.
Coverage details
Drug Max Out-of-Pocket
The most you'll pay out-of-pocket for prescriptions. It may be included within the medical max out-of-pocket.
Coverage details
Dental Coverage
Some plans include dental coverage for certain adult or child dental expenses.
Coverage details
Out-of-Pocket Costs
Also called cost sharing — what you pay for care (deductible, copays, coinsurance) until plan limits are met.
Coverage details
Preventive Care
All plans must provide preventive services at no cost, such as checkups and certain lab tests.
Coverage details
Primary Care Visit
A visit with a primary care physician, nurse, or provider for services not considered preventive care.
Coverage details
Specialist Visit
A visit with a physician who specializes in a specific area of medicine to diagnose, manage, or treat certain conditions.
Coverage details
Emergency Room
A visit to the ER to evaluate and treat an emergency medical condition.
Coverage details
Inpatient Facility
The facility cost for care you receive when admitted as an inpatient, such as at a hospital or skilled nursing facility.
Coverage details
Inpatient Physician
The provider cost for care you receive when admitted as an inpatient at a health care facility.
Coverage details
Generic Drugs
Tier 1 drugs — your lowest-cost prescription option.
Coverage details
Preferred Brand Drugs
Tier 2 drugs — a midrange-cost prescription option.
Coverage details
Non-preferred Brand Drugs
Tier 3 drugs — a higher-cost prescription option.
Coverage details
Specialty Drugs
Tier 4 drugs — additional high-cost prescription options.
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Definitions are provided for research and educational purposes. Health Plan Radar is not affiliated with the federal marketplace. For official information, visit HealthCare.gov.