Health Insurance Glossary: Key Terms Every Florida Consumer Should Know
Published by SpaceCoastHealth.org · Updated July 2026
Health insurance comes with its own vocabulary, and understanding these terms is the first step toward choosing a plan that truly fits your budget and care needs. Whether you are comparing ACA Marketplace plans in Brevard County, evaluating a Health First HMO, or simply trying to read your Explanation of Benefits, the definitions below explain the concepts that most influence what you pay. SpaceCoastHealth.org built this glossary so Space Coast residents can shop for coverage with confidence — and ask a licensed local agent the right questions.
Plan Costs & Payments
- Premium
- The fixed amount you pay each month to keep your health insurance plan active, whether or not you use medical services that month. On the ACA Marketplace, premiums can be sharply reduced by premium tax credits for eligible Florida households.
- Deductible
- The amount you pay out of pocket for covered health care services before your insurance begins to share the cost. A high-deductible plan usually has a lower monthly premium, while a low-deductible plan costs more each month.
- Copayment (Copay)
- A set dollar amount you pay for a covered service at the time you receive care — for example, $25 for a primary care visit or $10 for a generic prescription. Copays may apply before you meet your deductible.
- Coinsurance
- Your share of the cost of a covered service, shown as a percentage (such as 20%) that you pay after your deductible has been met. Your plan pays the remaining percentage.
- Out-of-Pocket Maximum
- The most you would ever pay for covered, in-network services in a single plan year. Once you reach this limit, your insurance pays 100% of covered essential health benefits for the rest of the year.
Plan Types & Networks
- Network
- The group of doctors, hospitals, pharmacies, and other providers your plan has contracted with to deliver services at negotiated rates. Staying in-network almost always costs you less.
- HMO (Health Maintenance Organization)
- A plan that typically requires you to choose a primary care physician and obtain referrals before seeing specialists, and that generally only covers care received inside its network.
- PPO (Preferred Provider Organization)
- A plan that gives you the flexibility to see out-of-network providers without a referral, though at a higher cost. PPOs usually carry higher monthly premiums than HMOs.
- EPO (Exclusive Provider Organization)
- A plan that combines HMO-style in-network restrictions with PPO-style freedom from referrals — you can see specialists directly, but out-of-network care is generally not covered except in emergencies.
- Formulary
- The list of prescription medications covered by your health plan, usually organized into tiers. Lower tiers (generics) cost less, while higher tiers (brand-name or specialty drugs) cost more.
Enrollment & Financial Help
- Metal Tiers (Bronze, Silver, Gold, Platinum)
- ACA plan categories that describe how you and the insurer split costs. Bronze plans have the lowest premiums and highest out-of-pocket costs; Platinum is the reverse. Silver plans uniquely pair with cost-sharing reductions that lower deductibles and copays for eligible lower-income households.
- Premium Tax Credit (Subsidy)
- A federal credit under the Affordable Care Act that lowers your monthly premium based on household income and size. Many Brevard County residents qualify for a credit that reduces their premium to $0 per month.
- Cost-Sharing Reduction
- A subsidy available only with Silver-tier plans that lowers your deductibles, copays, and coinsurance when your income falls within certain thresholds.
- Special Enrollment Period (SEP)
- A limited window outside of Open Enrollment during which you can enroll in or change plans after a qualifying life event — such as losing job-based coverage, getting married, having a baby, or moving to a new county.
- Open Enrollment Period (OEP)
- The annual window (typically November 1 through January 15 in Florida) when anyone can enroll in or switch an ACA Marketplace plan without a qualifying event.
Still unsure how a term applies to your situation? A licensed Space Coast agent can translate these concepts into real dollar figures for your household — showing you exactly what each plan would cost after subsidies, what your doctors charge in-network, and which tier makes the most sense for your expected care. This guidance is completely free.