Module 7 lecture, part 3 Flashcards
How many tiers are there of marketplace plans?
4
What are marketplace premiums, cost, and cost sharing based on?
Actuarial value
To whom are marketplace premium subsidies available?
100-400% of the federal poverty level via tax credits
What are the mandated essential health benefits under the ACA?
Ambulatory pt svcs
Emergency svcs
Hospitalization
Maternity and newborn care
Mental health and substance use disorder svcs, including behavioral health tx
Prescription drugs
Rehabilitative and habilitative svcs and devices
Laboratory svcs
Preventive and wellness svcs and chronic dz mgmt
Pediatric svcs, including oral and vision care
Till when was the ACA employer mandate postponed?
2015
To whom does the ACA employer mandate apply?
Employers with 50 or more full-time equivalent workers
What is the play or pay mandate?
Provide health insurance or pay a penalty
-When an employee employed by a large employer gets federal subsidy
-When the health plan offered fails the “minimum value” and “affordability” tests
What is the minimum value test?
At least equivalent to the Bronze plan offered through the exchanges
What is the affordability test?
Employer’s share of the premium for a single plan is less than or equal to 9.5% of the HH income
Trends in small business insurance coverage
Declined since the passage of ACA
What is the projection on employment-based health insurance?
Fewer ppl will have it
More ppl will be qualified for subsidies
More burden will be on the gov’t
What fraction of Americans had public health insurance in 2011?
Almost 1/3
What insurance programs are publicly financed?
Medicare
Medicaid
CHIP
Military Health Svcs
Veterans Health Administration
Indian Health Service
Which legislation established Medicare?
Title XVIII of SSA
What type of program is Medicare?
Federal, consistent across the nation
What type of additional tax for Medicare was implemented by the ACA from 2013 onward?
0.9% of payroll tax on individuals earning $200K+ and married couples earning $250K+
What are the three groups of Medicare beneficiaries?
65 yrs and older
Disabled entitled to social security
Those with end stage renal dz
What percentage in 2015 on Medicare were 65 and older?
84%
What are the parts of Medicare?
A
B
C
D
What is Medicare part A?
Hospital insurance
How is Medicare part A financed?
mandatory payroll taxes
Employer and employee pay equally into the Hospital Insurance Trust Fund
When are no premiums required for Medicare part A?
If a person or spouse has worked and earned 40 credits
Medicare part A benefits
90 days of inpatient hospital care per benefit period
Lifetime care of 190 days in a psych hospital
Up to 100 days of care in a Medicare-certified SNF subsequent to inpt hsopitalization
Home health care through a Medicare-certified agency
Hospice care
What is Medicare part B generally?
Supplemental medical insurance
Covers various outpt svcs
Means-testing and Medicare part B
Started in 2007
A higher income threshold triggers Income Relative Monthly Adjustment Amount (IRMAA)
Results in higher premium
Trends of those who enroll in Medicare part A and enrolling in part B
Almost all with Part A enroll with part B
