Affordable Care Act

Question 1

when was the affordable care act signed into law and by whom

Answer 1

2010 barack obama

Question 2

what is one significant difference that obamacare achieved

Answer 2

all insurers must now offer different levels of coverage AND offer coverage for preexisting conditions

Question 3

before obamacare, there were millions uninsured and without basic healthcare.
this resulted in minor medical conditions becoming…..

Answer 3

chronic diseases such as diabetes and heart disease

Question 4

true or false

pre-ACA, health insurance companies could refuse to cover anyone with a preexisting condition

Answer 4

true

Question 5

what is a preexisting condition

Answer 5

a health condition that existed before getting new insurance

Question 6

true or false

under ACA, health insurers can still refuse coverage based on a preexisting condition, but there are limitations

Answer 6

FALSE — no insurer can deny someone with a preexisting conditi

Question 7

through ACA, more americans have access to health insurance and healthcare.
they also have increased access to ___ ___ resources

Answer 7

mental health

Question 8

ACA is a federal law that reduces ______ costs and expands ____

how does it achieve this?

Answer 8

reduces health insurance costs and expands coverage

achieves thorugh shared responsibility of the government, employers, and policyholders

Question 9

ACA also aims to prohibit the ____ practices of the health insurance industry

Answer 9

RESTRICTIVE

Question 10

name 4 ways in which ACA subsidized health care

Answer 10

-direct subsidies (medicaid)

-medicaid expansion

-reduced medicare reimbursements to healthcare providers under medicare advantage – savings helped to subsidize older americans care

-premium tax credits

Question 11

what is the result of medicaid expansion under ACA

Answer 11

medicaid now covers adults who work but can’t afford healthcare (adults w a household income below 138% of FPL)

Question 12

how many states have expanded medicaid coverage?

Answer 12

over 40, as well as the district of columbia

Question 13

explain what premium tax credits are under ACA

Answer 13

-depend on a person’s household income

-lowers their monthly insurance premiums. these credits can be used every month

-if they DONT use these credits, they can request a refund on their tax return

Question 14

name 3 insurance regulations that obamacare implemented

Answer 14

prohibited from:

-canceling policies when policyholder became sick

-placing a lifetime monetary limit on hospital stay or other essential benefits

-denying coverage for preexisting conditions

Question 15

explain the individual mandate and what happened to it

Answer 15

it was a penalty for people who didn’t buy a health insurance plan. an effort at cost sharing

intent was to get close to universal coverage. this would offset the cost of insurance and healthcare for people who couldn’t pay

repealed by congress in 2017 – doesn’t exist anymore

Question 16

true or false

among its other accomplishments, Obamacare also reduced the waiting time for new employees to get insurance

Answer 16

true

Question 17

who implements the ACA? through what?

Answer 17

dept of health and human services implements through the Health Insurance Marketplace

Question 18

what can you say about insurance coverage of ER visits under Obamacare

Answer 18

beneficiaries can use any out of network ER without penalty

Question 19

what are the 4 categories of coverage offered in the Health Insurance Marketplace?

Answer 19

bronze
silver
gold
platinum

Question 20

what are “premium plans” on the health insurance marketplace?

Answer 20

they pay more of the costs of expensive medical services

Question 21

low income families may qualify for what 2 programs?

Answer 21

medicaid and CHIP

Question 22

explain what CHIP is

Answer 22

childrens health insurance program

ensures low income children receive pediatric care including vaccines, wellness checks, and other routine medical care

Question 23

what was the most controversial provision of obamacare?

Answer 23

the individual mandate

Question 24

WHY was the individual mandate controverisal

Answer 24

healthy ppl paying regular premiums had to help cover healthcare costs for al

Question 25

the federal gov uses new initiatives yearly to inform americans about health insurance. this includes outreach to whom? why?

Answer 25

local community health organizations and health centers
they understand the health status of community members and have better access to potential beneficiaries of the ACA

Question 26

does obamacare have options for small business owners?

Answer 26

yes.
businesses with less than 50 full time employees can get health and dental insurance for their employees

Question 27

what are 3 things to know before you pick an insurance plan on the health insurance marketplace

Answer 27

-the 4 metal categories
-your total costs for healthcare (premiums, deductibles, out of pocket costs, etc)
-plan and network types (HMO, PPO, POS, EPO)

Question 28

Between EPO, HMO, PPO, and POS which is the most restrictive in terms of access and which is the least restrictive?
explain

Answer 28

most restrictive = HMO. limits coverage to DRs who work for or are in contract with the HMO. Won’t cover out of network except in an emergency. an HMO also may require you to live or work in its service area to be eligible for coverage

least restrictive = PPO
pay less if you use providers in network. however, you can use docotrs, hospitals, and providers outside of the network WITHOUT A REFERRAL for an additional cost

Question 29

explain EPO

Answer 29

exclusive provider organization

managed care plan where services are covered only if you use drs, specialists, or hospitals in the plan’s network (emergency is an exception)

Question 30

explain POS

Answer 30

point of service

plan where you pay less if you stay in network. require a referral to see a specialist

Question 31

in a platinum plan, the insurance company pays ___% for cost of care and you pay ___%

Answer 31

insurance company pays 90% you pay 10%

Question 32

in a bronze plan, the insurance company pays ___% for the cost of care and you pay ___%

Answer 32

insurance pays 60% and you pay 40%

Question 33

health plan categories in the marketplace are based on how you and your plan split the cost of care.
it has nothing to do with the ____ of care

Answer 33

QUALITY

Question 34

What 2 groups of people can buy a catastrophic plan under the health insurance marketplace

Answer 34

-people under 30

-people over 30 with a “hardship exemption” or “affordability exemption”

Question 35

what is an HSA plan
what is another word for it

Answer 35

HSA = health savings account-eligible plan

AKA HDHP (high deductible health plan)

HSA is a type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses

Question 36

if you enroll in an HSA eligible plan, you may pay a lower _______, but have a higher _______

Answer 36

lower premium but higher deductible

if you combine your HSA eligible plan with an HSA, you can pay that deductible + other qualified medical expenses

Question 37

true or false

HSA balance rolls over year to year

Answer 37

true

Question 38

under the tax law, HSA-eligible plans must set what 2 things?

Answer 38

a minimum deductible and a maximum out of pocket cost limit

minimum deductible– amt you pay b4 plan starts to pay

max out of pocket – most you have to pay per year

Question 39

true or false

HSA eligible plan deductibles are often significantly higher than the minimums and can even be as high as out of pocket costs

Answer 39

true