Insurance words, in both languages.
Each term with its Spanish equivalent, so letters and calls in either language make sense.
- ClaimReclamo
- The bill your doctor or hospital sends to your insurer.
- CoinsuranceCoaseguro
- A percentage of the cost you pay after the deductible, such as 20%.
- CopayCopago
- A fixed amount for a service, such as $30 for a doctor visit.
- Cost-sharing reduction (CSR)Reducción de costos compartidos (CSR)
- Extra discounts on deductibles and copays for lower incomes, only on Silver plans.
- DeductibleDeducible
- What you pay for covered services before the plan starts paying its share. Many preventive services skip the deductible.
- Drug list (formulary)Lista de medicamentos (formulario)
- The drugs your plan covers and at what cost tier.
- EPOEPO
- A plan that only covers in-network care (except emergencies) but doesn't require referrals.
- Explanation of benefits (EOB)Explicación de beneficios (EOB)
- A summary from your insurer of what was billed and what it paid. It is not a bill.
- Form 1095-AFormulario 1095-A
- The Marketplace form you need to file taxes if you had a Marketplace plan.
- HMOHMO
- A plan that usually requires in-network doctors and a referral to see specialists.
- HSAHSA
- A tax-advantaged health savings account. In 2027 it can be paired with Bronze and catastrophic Marketplace plans.
- MAGIMAGI
- Modified adjusted gross income: the income the Marketplace uses to figure your help.
- Medicare Advantage (Part C)Medicare Advantage (Parte C)
- Private Medicare-approved plans that replace Original Medicare and often include drugs and extras.
- Medicare Supplement (Medigap)Medicare Suplementario (Medigap)
- Insurance that helps pay what Original Medicare doesn't, such as deductibles and coinsurance.
- Open EnrollmentInscripción Abierta
- The time of year when anyone can enroll in or switch Marketplace plans.
- Out-of-pocket maximumGasto máximo de bolsillo
- The most you pay in a year for covered in-network care. After that, the plan pays 100%. In 2027 the legal limit is $12,000 per person.
- Part DParte D
- Medicare drug coverage. In 2027 the yearly out-of-pocket cap is $2,400.
- PPOPPO
- A plan with more freedom to see out-of-network doctors, at a higher cost.
- PremiumPrima
- What you pay each month to have coverage, whether you use it or not.
- Premium tax credit (APTC)Crédito fiscal (APTC)
- Government help that lowers your monthly premium based on your income and household.
- Prior authorizationAutorización previa
- Approval some plans require before covering certain services or drugs.
- Provider networkRed de proveedores
- The doctors, hospitals and pharmacies that contract with your plan.
- Qualifying life eventEvento de vida que califica
- A change such as losing coverage, moving, getting married or having a baby.
- Special Enrollment PeriodPeríodo de Inscripción Especial
- A window, usually 60 days, to enroll outside Open Enrollment after a life event.
No match. Ask your agent.
Want to talk through your situation?
A licensed agent reviews your options in Spanish or English, at no cost and with no obligation.