ACA glossary for 2027

The words you'll meet choosing 2027 coverage, in a sentence or two each.

Advance premium tax credit (APTC)
The premium tax credit paid to your insurer each month to lower your bill, instead of as a refund at tax time.
Affordable Care Act (ACA)
The federal law, also called Obamacare, that created the Marketplaces, the premium tax credit and Medicaid expansion.
Affordable job coverage
Job-based coverage whose cheapest plan for the employee alone costs 10.22% of household income or less in 2027. An offer of it blocks the tax credit. The 2027 affordability test
Basic Health Program
A state plan for incomes from 138% to 200% of the poverty line, in place of Marketplace plans. Minnesota, New York, Oregon and DC run one in 2027.
Benchmark plan
The second-lowest-cost silver plan where you live. The tax credit is set so this plan costs you a fixed share of income.
Catastrophic plan
A low-premium plan with a very high deductible, for people under 30 or with a hardship exemption. The tax credit can't be used on it.
CHIP
The Children's Health Insurance Program: low-cost coverage for children, and in some states pregnancy, in families that earn too much for Medicaid.
Coinsurance
Your share of a covered service's cost as a percentage, such as 20%, usually after the deductible.
Copayment (copay)
A set amount you pay for a covered service, such as a doctor visit or a prescription.
Cost-sharing reductions (CSR)
Extra savings on silver plans that lower deductibles and copays, for incomes from 100% to 250% of the poverty line. Cost-sharing reductions in 2027
Coverage Decider Score
Coverage Decider's 0-to-100 rating of how well a plan fits your likely yearly costs, protection in a bad year, your doctors and drugs, and plan quality. How we calculate
Coverage gap
Adults under 100% of the poverty line in states that didn't expand Medicaid, who get neither Medicaid nor a tax credit. The Medicaid coverage gap
Deductible
What you pay for covered care each year before the plan starts paying its share. Many plans cover some care, such as preventive visits, before the deductible.
EPO
Exclusive provider organization: a plan that covers in-network care only, except emergencies, usually without referrals.
Expected contribution
The share of income you're expected to pay for the benchmark plan, also called the applicable percentage. In 2027 it runs from 2.15% to 10.22% of income. Tax credit check
Federal poverty level (FPL)
The yearly income guideline HHS publishes, used to set Medicaid and tax credit eligibility. 2027 coverage uses the 2026 guidelines: $15,960 for one person in the 48 contiguous states and DC. FPL calculator
Formulary
A plan's list of covered drugs, grouped into tiers that set what you pay.
Health savings account (HSA)
A tax-free account for medical costs, open to people with an HSA-eligible plan. For 2027 you can put in up to $4,500 for yourself or $9,000 for a family, and from 2026 every bronze and catastrophic Marketplace plan qualifies.
HealthCare.gov
The federal Marketplace, where people in 29 states sign up for 2027 coverage.
HMO
Health maintenance organization: a plan that covers in-network care only, except emergencies, and often needs a referral to see a specialist.
Lawfully present
An immigration status that can qualify for Marketplace coverage. From 2027, fewer lawfully present immigrants can get the tax credit. ACA subsidies for immigrants in 2027
Marketplace
Where you buy an ACA plan and get the tax credit: HealthCare.gov in most states, or a state's own site, such as Covered California. Also called the exchange. 2027 rules by state
Medicaid
Public coverage for people with low incomes, run by each state under federal rules and with federal funding.
Medicaid expansion
The ACA option that covers adults 19 to 64 up to 138% of the poverty line. Forty states and DC have it. Medicaid income limits by state
Medicaid work requirement
From 2027, most adults covered through Medicaid expansion must show 80 hours a month of work, school, job training or volunteering, or qualify for an exemption. Medicaid work requirements in 2027
Metal tiers
Bronze, silver, gold and platinum plans, which pay about 60%, 70%, 80% and 90% of covered costs for an average person.
Minimum essential coverage
Coverage that counts under the ACA, such as Marketplace plans, job plans, Medicaid and Medicare. Having it can stop you from getting the tax credit.
Minimum value
A job plan that pays at least 60% of covered costs and substantially covers hospital and doctor care. A job plan without minimum value doesn't block the tax credit.
Modified adjusted gross income (MAGI)
The income the Marketplace and Medicaid count: adjusted gross income plus untaxed Social Security, tax-exempt interest and excluded foreign income.
Network
The doctors, hospitals and pharmacies a plan contracts with. Care outside it costs more or isn't covered.
Obamacare
Another name for the Affordable Care Act and the plans sold on its Marketplaces.
Open enrollment
The yearly window to sign up for or switch plans. For 2027 coverage on HealthCare.gov it runs Nov. 1, 2026 to Jan. 15, 2027. 2027 open enrollment dates
Out-of-pocket maximum
The most you pay for covered in-network care in a year. For 2027 the limit is $12,000 for one person and $24,000 for a family.
PPO
Preferred provider organization: a plan that covers care in and out of network, at a higher cost out of network, usually without referrals.
Premium
What you pay each month to keep a plan, whether or not you use care.
Premium tax credit
Federal help that lowers your premium for a Marketplace plan, for incomes from 100% to 400% of the poverty line in 2027. Tax credit check
Reconciliation
Comparing the advance credit you got with the credit you qualify for, on IRS Form 8962 with your tax return. From tax year 2026, there's no cap on what you pay back. Premium tax credit repayment in 2027
Special enrollment period (SEP)
A window outside open enrollment, usually 60 days, after a life event such as losing other coverage, moving, marrying or having a baby.
Subsidy cliff
The cutoff at 400% of the poverty line, above which there's no tax credit in 2027. The 2027 subsidy cliff
Tax household
Everyone you claim on your federal tax return. The Marketplace counts them to set your poverty level and tax credit.

FPL calculator · Tax credit check · All resources