Affordable Care Act

Question 1

Affordable Care Act

Answer 1

Also known as PPACA Obama Care and Health Care Reform

Signed in 2010 with some reforms

Additional reforms began Jan 2014

Question 2

Grandfathered vs Nongrandfathered policies

Answer 2

Grandfathered (existed before ACA)

Non grandfathered existed after ACA

Question 3

Individual mandate

Answer 3

Is Citizens and legal residents are required to have qualifying health care coverage

There is a tax penalty if they don’t (with some exceptions)

Question 4

Qualified health plan must have following essential health benefits

Answer 4

Ambulatory Patient Services
Emergency Services
Hospitalization 
Maternity and newborn care
Mental health and substance use disorder services
Prescription drugs
Rehab services and devices
Laboratory services 
Preventive and wellness services and chronic disease management 
Pediatric (oral and vision)

Question 5

Emergency medical services

Answer 5

No pre-authorization required

In network or out of network
Normal cost sharing requirements

Question 6

Primary care provider designation

Answer 6

Every insured and dependent must have a primary care provider

Question 7

Prohibition on Lifetime/Annual Limit

Answer 7

On all EHB (except grandfathered plans)

Limits allowed on non-EHBs

Question 8

Metal Tiers

Answer 8

4 levels of coverage, each must cover EHBs (Bronze 60%, Silver 70%, Gold 80% Platinum 90%)

Tiers represent average portion of expected costs

Percentages represent how much plan will pay

Question 9

Free Preventative Care

Answer 9

Take care of yourself now to prevent costly future chronic conditions

Question 10

Pre-existing conditions

Answer 10

Health plans can no longer exclude pre-existing conditions

Except grandfathered plans

Question 11

Coverage of children to age 26

Answer 11

Up to, not including 26,

Past 26 if unmarried, financially dependent, and have physical or mental impairment

Question 12

Eligibility

Answer 12

Depends on

• income
• employment status
• if you have coverage through employer

Question 13

Guaranteed issue

Answer 13

Must be offered to any individual or employer in state

Subject to rules

Question 14

Health Benefit Exchanges/Market places

Answer 14

Required
Operated by state or federal government
Annual open enrollment and special enrollment depending on qualifying events

Question 15

Qualified Health Plan

Answer 15

Only sold on exchange

Provide EHBs

Only plan that provides tax credits and cost sharing

Question 16

Small Business Health Options Program

Answer 16

Shop
- online application to compare health plans

• 50 or less full-time employees

Question 17

Subsidies

Answer 17

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

Question 18

Navigators

Answer 18

• Funded by Government through federal agents
• CANNOT sell insurance or provide advice
• Help Determine eligibility for public assistance

Question 19

Employer notification responsibility

Answer 19

Employers are required to inform employees about their rights to affordable coverage and possible subsidies

Question 20

Employer mandate-employer shared responsibility

Answer 20

For employers with more than 50 employees

Penalty if not followed

Exempt if less than 50 employees

Question 21

Health care tax credit for small employees

Answer 21

Maximum tax credit
- 50% of premiums paid for small business employers

• 35% of premiums paid for small tax-exempt employers
• eligible for 2 years