Affordable Care Act Flashcards
Affordable Care Act
Also known as PPACA Obama Care and Health Care Reform
Signed in 2010 with some reforms
Additional reforms began Jan 2014
Grandfathered vs Nongrandfathered policies
Grandfathered (existed before ACA)
Non grandfathered existed after ACA
Individual mandate
Is Citizens and legal residents are required to have qualifying health care coverage
There is a tax penalty if they don’t (with some exceptions)
Qualified health plan must have following essential health benefits
Ambulatory Patient Services Emergency Services Hospitalization Maternity and newborn care Mental health and substance use disorder services Prescription drugs Rehab services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric (oral and vision)
Emergency medical services
No pre-authorization required
In network or out of network
Normal cost sharing requirements
Primary care provider designation
Every insured and dependent must have a primary care provider
Prohibition on Lifetime/Annual Limit
On all EHB (except grandfathered plans)
Limits allowed on non-EHBs
Metal Tiers
4 levels of coverage, each must cover EHBs (Bronze 60%, Silver 70%, Gold 80% Platinum 90%)
Tiers represent average portion of expected costs
Percentages represent how much plan will pay
Free Preventative Care
Take care of yourself now to prevent costly future chronic conditions
Pre-existing conditions
Health plans can no longer exclude pre-existing conditions
Except grandfathered plans
Coverage of children to age 26
Up to, not including 26,
Past 26 if unmarried, financially dependent, and have physical or mental impairment
Eligibility
Depends on
- income
- employment status
- if you have coverage through employer
Guaranteed issue
Must be offered to any individual or employer in state
Subject to rules
Health Benefit Exchanges/Market places
Required
Operated by state or federal government
Annual open enrollment and special enrollment depending on qualifying events
Qualified Health Plan
Only sold on exchange
Provide EHBs
Only plan that provides tax credits and cost sharing