Chapter 2- Affordable Care Act Questions and Answers 2023

Patient Protection and Affordable Care Act more widely known as the Affordable Care Act or Obamacare. The act was enacted to expand coverage, hold insurance companies more accountable, lower healthcare costs, give people more choice for insurance, and increase the quality of healthcare/ health insurance. Essential health benefits include items and services in the following ten benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care. Health Insurance Marketplace Organizations that facilitate structured and competitive markets for purchasing health coverage. The Health Insurance Marketplace, or "Exchange," offers standardized health insurance plans to individuals, families and small businesses. Certain states operate their own marketplace, while others opt for a partnership exchange where the federal government manages the marketplace. In each state, various private insurance companies submit plans to be included in the marketplace. The marketplace plans are separated into four primary levels: Bronze, Silver, Gold and Platinum, each based on the average percentage the plan pays toward health-care services. Summary of Benefits and Coverage Offers people a way to compare health insurance plans, to help decide which one is the best for them, this was established by the ACA. Life Qualifying Event A change in someone's life which can make them eligible for a Special Enrollment Period- a time outside the yearly open enrollment period when you sign up for health insurance. Examples: marriage, having a baby, losing health coverage, etc. Public Plan Option A public health insurance option that would provide health insurance for people who cannot afford private health insurance premiums (government- run) Community First Choice A medicaid program (optional) that was created by the ACA to make it easier for states to offer home-and-community-based services to medicaid beneficiaries with disabilities ACA amendment to the Healthcare and Education Affordability Reconciliation Act of 2010 GOAL: improve the accessibility and quality of the US healthcare system 2010- ACA 1. Lifetime and unreasonable annual limits eliminated 2. Insurance companies could not deny for pre-existing conditions 3. National high-rise insurance pool was developed for individuals with pre-existing conditions who could not previously qualify 4. Dependent coverage extended to 26 years old 5. established so consumers could gain access to info about health insurance 2014- ACA 1. Insurance Co. prohibited from setting insurance rates based on health status, condition, genetic info, or other related factors 2. Health insurance marketplace established in each state 3. Insurance plans offered through private employers had to include the same essential health benefits as plans offered on the state-based Health Insurance Marketplaces 4. Individuals were required to have health insurance or annual fee 5. Insurance Co required to provide Summary of Benefits and Coverage so they can easily compare plans 6. Co-Ops were established in all 50 states 7. SHOP was developed Health Insurance Marketplaces -run by the federal or state gov. - Insurance coverage is provided by private health insurance co. -Central location for consumers to evaluate and purchase health insurance -Provide standardized info on the different types of insurance coverage -consumers complete application to determine types of coverage available to them based on their needs -consumers who make 100-400% of the federal poverty level qualify for subsidies 4 different levels of coverage -Bronze (60/40) -Silver (70/30) -Gold (80/20) -Platinum (90/10) Bronze- lowest premiums, higher out of pocket expenses Silver- "standard" plan Gold/ platinum- higher premiums, but lower out of pocket -not available in every area and offer fewer tax credits and subsidies for consumers Since passage of ACA -Medicaid eligibility has been expanded to cover individuals with lower incomes -A new medicaid benefit, community services to enrollees with disabilities -medicine beneficiaries can now receive an annual wellness visit with provider of choice free of charge Florida v. Sebelius regarding individual health insurance mandates and the national federation of independent business v. sebelius filed regarding Medicaid expansion