Unit 13 Affordable Care Act

Question 1

Affordable Care Act (ACA)

Answer 1

also known as PPACA, Obamacare, and Health Care Reform
signed in 2010 with some reforms
additional reforms began January 2014

Question 2

grandfathered

Answer 2

existed before ACA
costs cannot be increased
benefits cannot be reduced

Question 3

nongrandfathered

Answer 3

existed after ACA
must comply with all of ACA’s rules

Question 4

individual mandate

Answer 4

ACA required US citizens and legal residents to have qualifying health care coverage
ACA imposed a tax penalty if they do not have coverage (with some exceptions) - starting in 2019 the Tax Cuts and Jobs Act reduced the tax penalty to $0

Question 5

essential health benefits (EHB)

Answer 5

health plans must be qualified to fit ACA standards
QHPs, Medicaid state plans, and insurance on the health exchange must meet requirements

Question 6

emergency medical services

Answer 6

an essential health benefit
no pre-authorization required
in-network or out-of-network
normal cost-sharing requirements

Question 7

primary care provider designation

Answer 7

an essential health benefit
every insured and dependent must have a PCP

Question 8

prohibition on lifetime and annual limits

Answer 8

an essential health benefit
on all EHBs except for grandfathered plans
allowable on non-EHBs

Question 9

metal tiers

Answer 9

an essential health benefit
four levels of coverage; each must cover minimum EHBs
tiers represent average portion of expected costs
percentages represent how much plan will pay

bronze 60% coverage
silver 70% coverage
gold 80% coverage
platinum 90% coverage

Question 10

free preventive care

Answer 10

an essential health benefit
take care of yourself now to prevent costly, future, chronic conditions

Question 11

pre-existing conditions

Answer 11

an essential health benefit
physical or mental conditions present before the effective date
health plans can no longer exclude, except for grandfathered plans

Question 12

coverage of children

Answer 12

an essential health benefit
up to, not including, age 26
children can remain even if married, not living with parents, attending school, not financially dependent, or eligible to enroll in an employer’s plan
past age 26 if unmarried, financially dependent, and have a physical or mental impairment

Question 13

eligibility

Answer 13

an essential health benefit
depends on income, employment status, if you have coverage offered through employer

Question 14

guaranteed issue

Answer 14

an essential health benefit
must be offered to any individual or employer in the state
subject to rules regarding enrollment periods, networks

Question 15

health insurance marketplace

Answer 15

required
operated by the state or federal government
annual open enrollment and special enrollment depending on qualifying events

Question 16

qualified health plan (QHP)

Answer 16

provide EHBs
only available on the exchange
only plan that provides tax credits and cost sharing

Question 17

small business health options program (SHOP)

Answer 17

online application to compare health plans
50 or less full-time employees

Question 18

subsidies

Answer 18

a sum of money given by the federal government
advanced premium tax credits (APTC)
cost-sharing (only available in silver tier)

Question 19

navigators

Answer 19

funded by the government through federal grants
cannot sell insurance of provide advice
help determine eligibility for public assistance

Question 20

employer responsibilities

Answer 20

employer notification responsibilities - required to let employees know their rights to affordable coverage

employer mandate - employer shared responsibility
-for employer with 50 or more employee, penalty of $2,000 per employee if not followed
-exempt if there are fewer than 50 employees

Question 21

small employer tax credit

Answer 21

to be eligible, the employer must pay premiums on behalf of the employees
maximum credit:
-50% of premiums paid for small business employers
-35% of premiums paid for small tax-exempt employers
-eligible for two years