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

Images: Related links to external sites (from Bing)

Related Studies