II. Definitions

  1. Affordable Care Act
    1. Most U.S. citizens will require enrollment in a health insurance plan by 2014
    2. Those without a health plan will be penalized
    3. Low income assistance (e.g. individuals making less than $45,000/year)
    4. Very low-income assistance via Medicare
  2. Health Insurance Marketplace (health insurance exchange)
    1. Available as of October 2014 for U.S. consumers to compare and purchase health insurance plans
  3. Affordable Care Act Plans
    1. Health plans are comprehensive but with varying premiums, copays and pharmacy benefits
    2. Low cost plans for young healthy consumers (under age 30 years old) will primarily offer catastrophic coverage
    3. Annual wellness exams and health screenings are typically included at no added cost

III. Background: Goals of PPACA Legislation

  1. Regulation and coverage
    1. Coverage restrictions eliminated
  2. Coverage expanded
    1. Individual mandates to be insured
    2. Health insurance exchanges
    3. Individuals and employers may face penalties
    4. Medicaid expanded Cost containment
    5. Incentizes high quality, cost-effective care
    6. Patient-Centered Medical Home (PCMH)
      1. Facilitates patient coordinated care
    7. Accountable Care Organizations (ACOs)
      1. Network of doctors and hospitals who share financial and medical responsibility for providing medical care to a group of patients
    8. Independent Payment Advisory Board (IPAB)
      1. Federal agency adjusts reimbursement and coverage in the event costs are not met

IV. Resources

  1. Health Insurance Marketplace
    1. https://www.healthcare.gov/
  2. Medicaid ACA Timeline
    1. http://medicaid.gov/affordablecareact/timeline/timeline.html
  3. CMS ACA Information
    1. http://cms.gov/cciio/

V. References

  1. (2013) Presc Lett 20(9): 1

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Ontology: Patient Protection and Affordable Care Act (C2936611)

Definition (MSH) An Act prohibiting a health plan from establishing lifetime limits or annual limits on the dollar value of benefits for any participant or beneficiary after January 1, 2014. It permits a restricted annual limit for plan years beginning prior to January 1, 2014. It provides that a health plan shall not be prevented from placing annual or lifetime per-beneficiary limits on covered benefits. The Act sets up a competitive health insurance market.
Concepts Regulation or Law (T089)
MSH D058991
English Health Care Reform Act, PL111 148, 111-148, PL, Public Law 111-148, Public Law 111 148, PL 111-148, Patient Protection and Affordable Care Act, PL111-148, PL 111 148, Affordable Care Act (ACA), Care Act, Affordable (ACA), Acts, Affordable Care (ACA), Care Act, Affordable, Acts, Affordable Care, Act, Affordable Care, Affordable Care Act, Affordable Care Acts, Obamacare, Care Acts, Affordable
French PL 111-148 (USA), Loi de réforme des soins de santé, Public Law 111-148 (USA), Health Care Reform Act (USA), Patient Protection and Affordable Care Act (USA), Loi sur la protection des patients et les soins abordables
German Gesundheitsreformgesetz, Health Care Reform Act, Patient Protection and Affordable Care Act, Gesundheits-Reformgesetz
Czech Patient Protection and Affordable Care Act
Spanish Patient Protection and Affordable Care Act, Ley de Protección al Paciente y Cuidado de Salud Asequible
Portuguese Patient Protection and Affordable Care Act
Polish Patient Protection and Affordable Care Act
Italian Patient Protection and Affordable Care Act (U.S.)
Norwegian Patient Protection and Affordable Care Act