Lesson 3 Affordable Care Act (ACA)

How does the ACA protect health consumers?

Insurance companies are held accountable. They're now required to reinvest 80% of the money received from insurance premiums. As a result of ACA, insurance companies can't do the following: Deny paying claims, Create maximum annual payment limits, Create lifetime payment limits. Health consumers can now receive assistance with health insurance claims, more easily access information pertaining to coverage, and have the ability to challenge the decisions made by health care insurance carriers.

What is the Independent Payment Advisory Board (IPAB)

Reduce cost Eliminate waste Improve health care for seniors

What are Accountable Care Organizations (ACOs)

are groups of Docs, hospitals, and other health care providers who come together voluntarily to give coordinated high quality care to their Medicare patients.

Key Points- According to the ACA

current and future health care will be geared toward reducing discrimination.

Protection of People: 2013-2015

current and future health care will be geared toward reducing discrimination.

2010 The Patient's Bill of Rights

goes into effect to protect health care consumers

Key Points- Changes that came because of ACA

insurance for people with preexisting conditions, the ability of young adults to stay on their parents' insurance to age 26, an increase in Medicaid eligibility, and more.

Goal of Accountable Care Organizations (ACOs)

is to ensure that patients get the right care at the right time. By avoiding unnecessary duplication of services and preventing medical errors, ACOs help to reduce costs.

Key Points- The ACA includes

preventive services for seniors

ACA Benefits: 2013-2015

- Doctors receive higher reimbursement rates for treating patients who have Medicaid as their primary insurance. More individuals are also eligible to receive Medicaid coverage. - Individual states are receiving incentives to expand Medicaid coverage as they will receive 100% funding at the federal level through 2018. - Individuals who can afford health insurance are now required to enroll. Individuals may receive tax incentives for enrolling in health care plans. - In 2013, the Health Insurance Marketplace was created to allow individuals and businesses to apply for affordable health insurance coverage plans.

Affordable Care Act (ACA) refers to 2 parts

- Patient Protections and Affordable Care Act - Health Care and Education Reconciliation Act of 2010 Together, this legislation expands Medicaid coverage to include millions of low-income Americans and makes numerous improvements to both medicaid and CHIP.

The ACA seeks to accomplish the following:

- increase access to health care - protect people as health care consumers - improve the quality of health care - lower health care costs each state is responsible for carrying out this law, and many states are expanding their current Medicaid programs.

Key Points- ACA includes

1) The patient protection and affordable care act 2) The Health Care and Education Reconciliation act of 2010

How will the ACA ensure that health care continues to be affordable?

ACA guarantees the continued growth of the Health Insurance Marketplace with the goal of making insurance premiums more affordable to all.

Key Points- Result of the ACA

Children can't be denied health insurance because of a preexisting condition and insurance companies are being held more accountable.

How does the ACA benefit senior citizens?

Free preventative care such as wellness checkups Access to a community transition program- in which patient navigators assist seniors in accessing services within their communities- after being discharged from a hospital stay.

ACA places the allowing restrictions on heath insurance companies to protect health consumers:

Healthcare companies won't be allowed to charge higher rate related to an individual's gender or previous health care condition insurance companies can't refuse to pay if a person decides to participate in clinical trials. Insurance companies can't cap, or create a maximum on, the dollar amount an individual receives.

Protection of People- How will the ACA improve preventative health?

Heath care provider will be reimbursed based on quality of care rather than number of patients treated.

How will the ACA change insurance payments?

Insurance payments will be bundled to save money. A bundled payment simply means that one set amount of money will be distributed for each episode of care. One agency will be responsible for the distribution of funds. bundling payments will help lower costs and consumer costs because MDs will be able to agree to collaborate on the best Tx options for patients, as well as bid on a flat fee for specific services and treatments instead of billing multiple claims separately. This lowers the cost for the consumer because services and procedures are paid for in their entirety, rather than being billed separately on multiple claims.

IPABs and ACOs a responsible for monitoring health care reimbursement.

Medical billers and coders submit claims for Medicare patients. IPAB established by ACO under the ACA make projections about the amount of money that will be spent on reimbursement for hospital supplies and services provided in the MDs and hospital settings for Medicare patients.

2011 Preventative Services and Discounts

People with Medicare can get key preventative service for free, and may receive a 50% discount on brand name drugs.

ACA Access to health care benefits 7 major changes

Preexisting Condition Insurance Plan (PCIP) allows people with preexisting conditions, such as cancer, to qualify for health insurance. Young adults up to age 26 are able to stay on their parents health insurance. Many Americans who retired before the age of 65 without health insurance prior to 2014 fell under the early retiree insurance program. This program was available to US citizens ages 55-65. It helped by reimbursing health care providers to cover early retirees until the benefits of the ACA took hold on Jan 1st 2014. The ACA addresses the shortage of health care providers in certain areas, such as rural areas, by providing scholarships, loan forgiveness programs, and additional monies to those who practice in undeserved areas. Insurance companies are required to explain the costs of insurance premiums. This prevents excessive insurance charges. Medicaid eligibility numbers have increased for each state. Additional funding will be made available for building more community health centers

2012 Better Patient Care

Programs like ACO help doctors and health care providers work together to provide better patient care.

How does the ACA affect children's health insurance?

The ACA has made sure that children can't be denied health insurance based on preexisting conditions.