II. Definitions
- Affordable Care Act
- Most U.S. citizens will require enrollment in a health insurance plan by 2014
- Those without a health plan will be penalized
- Low income assistance (e.g. individuals making less than $45,000/year)
- Very low-income assistance via Medicare
- Health Insurance Marketplace (health insurance exchange)
- Available as of October 2014 for U.S. consumers to compare and purchase health insurance plans
- Affordable Care Act Plans
- Health plans are comprehensive but with varying premiums, copays and pharmacy benefits
- Low cost plans for young healthy consumers (under age 30 years old) will primarily offer catastrophic coverage
- Annual wellness exams and health screenings are typically included at no added cost
III. Background: Goals of PPACA Legislation
- Regulation and coverage
- Coverage restrictions eliminated
- Coverage expanded
- Individual mandates to be insured
- Health insurance exchanges
- Individuals and employers may face penalties
- Medicaid expanded Cost containment
- Incentizes high quality, cost-effective care
- Patient-Centered Medical Home (PCMH)
- Facilitates patient coordinated care
- Accountable Care Organizations (ACOs)
- Network of doctors and hospitals who share financial and medical responsibility for providing medical care to a group of patients
- Independent Payment Advisory Board (IPAB)
- Federal agency adjusts reimbursement and coverage in the event costs are not met
IV. Resources
- Health Insurance Marketplace
- Medicaid ACA Timeline
- CMS ACA Information
V. References
- (2013) Presc Lett 20(9): 1