Affordable Care Act
Red group
Luke, Trevor, Noah, Sarah
Multi- State Plans
Multi-State Plans was a program
created to provide additional
Noah
coverage for travelers in the Health Insurance Marketplace.
Used by people who travel often.
Most states offer multi-state plans (by 2017 all states
will).
Not any more expensive than other plans.
Insurance market and rating rules
Noah right to get a guaranteed issue on January
Everyone got the
1, 2014. The only thing that could vary it is age.
Tobacco use
Family Size
Geography
Those are the things that could raise the insurance premiums.
Benefit Tiers
They offer four different types ofNoahbenefit plans called metal
plans, plus a special plan offered through the Exchange. All
plans will provide minimum benefits and protections.
Bronze Plan: Offers the lowest premiums of all the plans
providing 60% of sharing costs. Covers 60% of out of pocket
costs, you pay the other 40%. You will save more on a bronze
plans premium then you will with any other program.
Benefit Tiers continued…
Noah
Silver plan: The Silver
plan is the Marketplace standard,
most people fall into this plan. It is the second lowest
covering 70% of out of pocket costs, you pay 30%. if you make
100%-250% of the FPL you will more than likely want to pick
the Silver plan.
Gold Plan: This plan is for some of the lowest income people
in the country where it covers 80% of your out of pocket
costs. Which still means you pay 80%.
More Benefit Tiers
Noah standard population will pay 90%
Platinum Plan: For this plan
of this plan's out of pocket dues. The platinum plan has the
highest premium on average. Not all states offer the platinum
plan depending on their minimum standards. If you have a low
income and lots of medical services this is the best plan to
have.
Catastrophic Plan: This plan is offered for young adults
under the age of 30. Low premiums, High deductibles, and high
cost sharing amounts. They also won’t pay any out of pocket
costs.
Basic Health Plan
*Health Care Exchange: Free marketSarahof health insurance
companies under federal regulation
*FPL: Federal Poverty Level
*ACA: Affordable Care Act
Basic Health Plan COntinued…
*133%-200% FPL can receive
Federal Aid on Premiums
Sarah
~Only for essential health benefits
~Not Medicaid
~Not for Elite Plans with costs (Gold and Platinum)
Essential Benefits Package
* Policies offered by the private
Sarah
insurance companies have to offer
essential benefits
~Failure to complete this results
in lack of certification
~Covers at least 60% of Costs
~Not more extensive than the normal
employer plan
Essential Benefits Package
Sarah the following categories to
*Have to include care within
become certified
~Ambulatory Patient Services
~Emergency Services
~Hospitalization
~Maternity/Newborn Care
~Mental Health/Substance Abuse Disorder Care
Essential Benefits Package Continued
~PediatricSarahServices(Including Oral and Vision Care)
~Preventative Wellness Services
~Chronic Disease Management
~Laboratory Services
~Prescription Drugs
~Rehabilitative and habilitative services and devices
Abortion Coverage
Sarah
*Can prohibit plans in exchange offering Abortion services
~ only require abortion in life of mother, rape,
incest
*Can’t raise rates for use
~Discrimination
Abortion Coverage
Sarah
*Coverage through the ACA is determined
by actual cost and
the cost of ¨Abortion Benefit.¨
~Reduce subsidy to prevent coverage
~Minimum $1 per enrollee
*Effective as of January 1, 2014
Abortion Coverage
Sarah
*Need estimates before coverage
~Costs up to $800 for the Abortion Pill
Used up to 9 weeks
Effective 97 times out of 100
~Costs up to $1500 for the in-clinic abortion
procedure
Vacuum Aspiration used up to 16 weeks
Concerns
*Taxes for subsidies???
*Plan costs/timely matter?
*Insurance Company Profit?
*Abortion Controversy (Coverage)
Sarah
Tax changes related to Health insurance
luke
❖ A new Medicare tax of 0.9 percent was added on January 1,
2013. The 0.9 percent applies to wage,Railroad Retirement
Act, and self-employment that exceeds a threshold
anywhere from $125,ooo to $250,000
individual Tax changes
luke children under the age of 27 they
➢If an employee has
normally are tax free for the employee.
➢ This change also include people that are self employed.
➢Tax on insurers of employer based plans with high values.
changes related to financing health reforms
New annual fees on pharmaceutical manufacturers
New annual fees on the health insurance sector
Non-profit insurers only half of net premiums are taken
into account.
tax on medical devices
Luke on taxable medical devices.
A 2.3 percent tax increase
Limit employee compensation
Add 10 percent tax on the amount paid for indoor tanning
beds
creation and structure of health insurance
Luke
Make state
based health benefit exchanges
Businesses with less than 100 employees can qualify
http://www.wahbexchange.org/
eligibility in the exchange
Luke U.S citizens are eligible to get
People who are legal
insured.
Consumer Operated and Oriented Plan
Created in all 50 states and District of Columbia to offer
trevor
qualified health plans. In order to be eligible to
receive funds your organization must meet the
requirements.
Requirements: can’t be an existing health insurer, can’t be
sponsored by state or local government, operate with a
strong consumer focus, profits must be used to lower
premiums.
Qualifications of participating health plans
trevor
Meet marketing
requirements
Use uniform enrollment form and standard format to present
plan information
Qualifications of participating health plans
Have adequate provider networks
Be accredited with respect to performance on quality
measures
Requirements of the exchanges
trevor
Exchanges
must have a call center for customer service
Must submit financial reports to the Secretary
States can apply for state health subsidy programs online,
in person, mailed, or by phone but requires them to
develop a single form for applying
Determine procedures to figure out eligibility for tax
credits
What the Exchanges look like
Luke skaw work cited
"Affordable Care Act Tax Provisions." Affordable Care Act Tax Provisions. IRS, 11 Jan. 2016. Web. 11 Jan. 2016.
"Washington Health Benefit Exchange." Washington Health Benefit Exchange. N.p., n.d. Web. 11 Jan. 2016.
Noah Price Works Cited
http://obamacarefacts.com/bronze-plan/
http://obamacarefacts.com/silver-plan/
http://obamacarefacts.com/gold-plan/
http://obamacarefacts.com/platinum-plan/
https://www.cms.gov/cciio/programs-and-initiatives/healthinsurance-market-reforms/market-rating-reforms.html
http://obamacarefacts.com/multi-state-health-plans/
Works Cited
https://www.plannedparenthood.org/learn/abortion/the-abortion-pill
Sarah
https://en.wikipedia.org/wiki/Subsidy
http://www.mnbudgetproject.org/research-analysis/economic-security/poverty-income/federal-poverty-guidelines
http://www.mnjinsurance.com/understanding-the-metal-levels-in-aca/
http://content.time.com/time/health/article/0,8599,1653411,00.html
https://www.healthcare.gov/glossary/essential-health-benefits/
https://www.ehealthinsurance.com/resource-center/affordable-care-act/minimum-essential-coverage-10-essentialbenefits
http://pregnancylansing.com/abortion/
http://www.clipartlord.com/category/transportation-clip-art/cars-clip-art/ambulance-clip-art/
https://expertbeacon.com/how-early-and-often-children-should-have-comprehensive-eye-exam