Adverse Selection – The process by which people who do not feel they need health insurance choose not to buy insurance, thus creating one pool of healthy, uninsured individuals and another of disproportionately less healthy insured individuals, driving up the cost of insurance.
Agency for Healthcare Research and Quality (AHRQ) – An agency within the Department of Health and Human Services (HHS) that supports research on health care management.
Annual Benefit Limit – An annual monetary limit placed on individuals by insurance companies, beyond which the insurer will no longer pay for services.
Anti-Injunction Act of 1867 – An American law stating that legal challenges to a tax may not be filed in the U.S. court system until the tax has come into effect. If the Supreme Court decides that the fees imposed by the Patient Protection and Affordable Care Act for not purchasing insurance are a tax, then the Supreme Court would not be able to rule on the Act until 2014, when the fines come into effect.
Any Willing Provider – A principle employed by some state laws stating that insurers must allow patients to work with “any willing provider” who is properly licensed to provide the required service.
Affordable Insurance Exchange (Health Insurance Exchange) – Health insurance markets set up by the Affordable Care Act that offer additional transparency requirements and easier comparison between competing health plans.
Balance Billing – The bill given to a patient by a health care provider entailing the costs above the level that the patient’s insurer will pay.
Basic Health Plan (BHP) – Insurance plans covering basic services as defined in the Patient Protection and Affordable Care Act provided by states with federal subsidies to individuals between 133 and 200 percent of the poverty level as an alternative to that state’s health insurance exchange. Scheduled to open in 2014 by the Patient Protection and Affordable Care Act.
Carve-out – Cost-saving strategy employed by insurers to outsource specific services to other companies.
Center for Consumer Information and Insurance Oversight – An agency within the Department of Health and Human Services (HHS) tasked with overseeing state health insurance exchanges, high-risk pools, early retiree reinsurance programs, and regulations on insurance costs. Created by the Patient Protection and Affordable Care Act.
Centers for Medicare & Medicaid Services (CMS) – Federal agency tasked with administering Medicare, Medicaid, and the Children’s Health Insurance Program.
Children’s Health Insurance Program (CHIP) – Jointly state- and federal-funded public health insurance program that provides health insurance to low-income children and some families who earn too much to qualify for Medicaid but not enough to afford private health insurance.