Affordable Care Act Flashcards
What is the Individual Mandate in ACA?
- All US citizens must have qualified health
insurance or pay a penalty - Individual penalty starts at $95, or up to 1% of income
- Families have limit of $2,085.
- This rises to $695 or 2.5% of income in 2016
What is “Play or Pay” in ACA?
Employer Shared Responsibility aka
- For groups with 50 – 99 employees, it does not apply
until 2015 - For employers that have 100+ employees, it begins in
2015 - In 2015, employers will have to offer coverage to at least 70% of their full-time employees
In 2016 and beyond, employers will have to offer coverage to ate least 95% of their full time employees
Full-time employee is 30 or more hours per week
Variable employees
Average 30 or more hours per week of 130 per month
Transitional Reinsurance Program
Enacted to help stabilize premiums in the individual market
– Fee of $63 per plan participant (includes dependents); the fee has been decreased to $44 for 2015
- Fully insured plans will be paud by carrier and included in premiums
Health Insurance Tax
Annual fee placed on health insurers starting 1/1/2014 to help states fund the exchanges
– Estimated to be between 2 – 2.5% in 2014 and 3-4% in 2015 and beyond.
- Fee on medical, dental & vision
Cadillac Tax
- 40% Excise Tax on the value of coverage exceeding $10,200 for individual and $27,500 for family
– The insurance coverage subject to the tax includes the value of the total premium for the employer-provided accident and health coverage, employer and employee contributions to health flexible savings account (FSA), and employer and employee salary reduction contributions to health savings accounts (HSA).
Alias for Obamacare
- Patient Protection and Affordable Care Act
- PPACA
- ACA
- Obamacare
When as ACA Passed?
Passed on March 23, 2010.
Goal of ACA?
Goal was to improve accessibility/affordability of health insurance and decrease uninsured rate.
When do regulation start?
Regulations began in 2010 and continue through 2018 with many of the bigger impacts effective January 1, 2014
Preventative Services in ACA
Preventative Services Covered at 100% In-Network – Annual check-up, testing; colon, breast, diabetes, cholesterol, high blood pressure and pre-natal vitamin deficiency, well-baby visits, routine vaccinations, childhood
immunizations, adult boosters, vision and hearing exams for children, weight loss counseling for children, women’s health screenings, smoking cessation counseling, obesity screening and AIDS testing
Change to Pre-Existing Conditions
Pre-Ex cannot apply to children.
Mandated Patient Protections
- PCPs (Notification)
- OB-GYNs (access without a referral)
- Emergency Room Care (In/out if network)
How long are children covered?
Covering Dependent Children to Age 26.
Initial Reforms - 2010
Non-Discrimination Requirements for Fully Insured Plans
– must not establish any eligibility rules that discriminate in favor of higher-wage employees.
– Current status – non enforcement, final regulations are yet to be released.
Small Business Tax Credit
Up to 25 full time employees, average wages less than $50,000 and contributes 50% or more
of the total premium
– 35% tax credit for 2010 – 2013
– 50% in 2014
Reforms in 2011
- HSA/FSA for over the counter (OTC) Medications
- Medicare Part D
- Employer notification due annually prior to October 15th
HSA Penalty
- Increased to 20% from 10%
