Module 7 lecture, part 3

Question 1

How many tiers are there of marketplace plans?

Answer 1

4

Question 2

What are marketplace premiums, cost, and cost sharing based on?

Answer 2

Actuarial value

Question 3

To whom are marketplace premium subsidies available?

Answer 3

100-400% of the federal poverty level via tax credits

Question 4

What are the mandated essential health benefits under the ACA?

Answer 4

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

Question 5

Till when was the ACA employer mandate postponed?

Answer 5

2015

Question 6

To whom does the ACA employer mandate apply?

Answer 6

Employers with 50 or more full-time equivalent workers

Question 7

What is the play or pay mandate?

Answer 7

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

Question 8

What is the minimum value test?

Answer 8

At least equivalent to the Bronze plan offered through the exchanges

Question 9

What is the affordability test?

Answer 9

Employer’s share of the premium for a single plan is less than or equal to 9.5% of the HH income

Question 10

Trends in small business insurance coverage

Answer 10

Declined since the passage of ACA

Question 11

What is the projection on employment-based health insurance?

Answer 11

Fewer ppl will have it
More ppl will be qualified for subsidies
More burden will be on the gov’t

Question 12

What fraction of Americans had public health insurance in 2011?

Answer 12

Almost 1/3

Question 13

What insurance programs are publicly financed?

Answer 13

Medicare
Medicaid
CHIP
Military Health Svcs
Veterans Health Administration
Indian Health Service

Question 14

Which legislation established Medicare?

Answer 14

Title XVIII of SSA

Question 15

What type of program is Medicare?

Answer 15

Federal, consistent across the nation

Question 16

What type of additional tax for Medicare was implemented by the ACA from 2013 onward?

Answer 16

0.9% of payroll tax on individuals earning $200K+ and married couples earning $250K+

Question 17

What are the three groups of Medicare beneficiaries?

Answer 17

65 yrs and older
Disabled entitled to social security
Those with end stage renal dz

Question 18

What percentage in 2015 on Medicare were 65 and older?

Answer 18

84%

Question 19

What are the parts of Medicare?

Answer 19

A
B
C
D

Question 20

What is Medicare part A?

Answer 20

Hospital insurance

Question 21

How is Medicare part A financed?

Answer 21

mandatory payroll taxes
Employer and employee pay equally into the Hospital Insurance Trust Fund

Question 22

When are no premiums required for Medicare part A?

Answer 22

If a person or spouse has worked and earned 40 credits

Question 23

Medicare part A benefits

Answer 23

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

Question 24

What is Medicare part B generally?

Answer 24

Supplemental medical insurance
Covers various outpt svcs

Question 25

Means-testing and Medicare part B

Answer 25

Started in 2007
A higher income threshold triggers Income Relative Monthly Adjustment Amount (IRMAA)
Results in higher premium

Question 26

Trends of those who enroll in Medicare part A and enrolling in part B

Answer 26

Almost all with Part A enroll with part B