Affordable Care Act Flashcards

1
Q

Affordable Care Act

A

Also known as PPACA Obama Care and Health Care Reform

Signed in 2010 with some reforms

Additional reforms began Jan 2014

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2
Q

Grandfathered vs Nongrandfathered policies

A

Grandfathered (existed before ACA)

Non grandfathered existed after ACA

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3
Q

Individual mandate

A

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)

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4
Q

Qualified health plan must have following essential health benefits

A
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)
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5
Q

Emergency medical services

A

No pre-authorization required

In network or out of network
Normal cost sharing requirements

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6
Q

Primary care provider designation

A

Every insured and dependent must have a primary care provider

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7
Q

Prohibition on Lifetime/Annual Limit

A

On all EHB (except grandfathered plans)

Limits allowed on non-EHBs

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8
Q

Metal Tiers

A

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

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9
Q

Free Preventative Care

A

Take care of yourself now to prevent costly future chronic conditions

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10
Q

Pre-existing conditions

A

Health plans can no longer exclude pre-existing conditions

Except grandfathered plans

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11
Q

Coverage of children to age 26

A

Up to, not including 26,

Past 26 if unmarried, financially dependent, and have physical or mental impairment

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12
Q

Eligibility

A

Depends on

  • income
  • employment status
  • if you have coverage through employer
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13
Q

Guaranteed issue

A

Must be offered to any individual or employer in state

Subject to rules

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14
Q

Health Benefit Exchanges/Market places

A

Required
Operated by state or federal government
Annual open enrollment and special enrollment depending on qualifying events

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15
Q

Qualified Health Plan

A

Only sold on exchange

Provide EHBs

Only plan that provides tax credits and cost sharing

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16
Q

Small Business Health Options Program

A

Shop
- online application to compare health plans

  • 50 or less full-time employees
17
Q

Subsidies

A
  • a sum of money given by the federal government
  • advanced premium tax credits (aptc)
  • Cost-sharing (only available in silver tier)
18
Q

Navigators

A
  • Funded by Government through federal agents
  • CANNOT sell insurance or provide advice
  • Help Determine eligibility for public assistance
19
Q

Employer notification responsibility

A

Employers are required to inform employees about their rights to affordable coverage and possible subsidies

20
Q

Employer mandate-employer shared responsibility

A

For employers with more than 50 employees

Penalty if not followed

Exempt if less than 50 employees

21
Q

Health care tax credit for small employees

A

Maximum tax credit
- 50% of premiums paid for small business employers

  • 35% of premiums paid for small tax-exempt employers
  • eligible for 2 years