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Affordable Care Act (ACA) Highlights
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Ban on Rescissions
Prohibits insurers from canceling coverage once an individual gets sick, as long as the customer does not commit fraud. Provides more security to the insured.
Closing the Medicare Part D 'Donut Hole'
Provides discounts to seniors on prescription drugs when they fall into the coverage gap in Medicare Part D. Aims to make medication more affordable for the elderly.
Dependent Coverage
Allows children to stay on their parents' health insurance until age 26. Designed to provide coverage to young adults during transition periods.
Pre-existing Conditions
Insurers cannot deny coverage or charge higher premiums based on pre-existing conditions. Ensures more equitable access to health insurance.
Center for Medicare & Medicaid Innovation
Established to test innovative payment and service delivery models to reduce costs while preserving or enhancing quality of care. Intended to improve the effectiveness of Medicare and Medicaid.
Preventive Services
Requires coverage of preventive care without cost-sharing such as copayments or deductibles. Aims to promote health maintenance and early detection of disease.
National Health Workforce Commission
Creates a commission to review healthcare workforce and projected workforce needs. The goal is better alignment of workforce resources with healthcare demands.
Premium Tax Credits
Subsidies provided on a sliding scale to individuals and families to help pay for health insurance premiums. Intended to make coverage through health insurance exchanges more affordable.
Nutrition Labeling of Standard Menu Items
Requires calorie information to be displayed on menus and menu boards of chain restaurants. A public health strategy aimed at combating obesity by informing consumer choices.
Employer Mandate
Requires employers with 50 or more full-time employees to provide health insurance or pay penalties. Intended to extend health security to more workers.
Medicaid Expansion
Expands Medicaid to cover all adults with income up to 138% of the federal poverty level. Designed to increase health care access for low-income individuals and families.
Community Health Center Funding
Increases funding for community health centers to provide care for millions of Americans. Aims to improve access to primary care services in underserved areas.
Health Insurance Exchanges
Marketplaces established for individuals and small businesses to compare and purchase health insurance plans. Aimed to provide greater choice and transparency in the health insurance market.
Essential Health Benefits
A set of 10 categories of services health insurance plans must cover under the ACA. It ensures comprehensive coverage, including preventive services and mental health.
Summary of Benefits and Coverage
Requires health plans to provide a standardized summary document to help consumers understand and compare health insurance options. Ensures transparency and informed decisions.
Tanning Services Tax
Imposes a 10% excise tax on indoor tanning services. Implemented as a public health measure against skin cancer and to offset some of the costs of the ACA.
Medical Loss Ratio
Insurers must spend at least 80% of premium dollars on medical care rather than administrative costs. This is to ensure value for the premium dollars paid by consumers.
Non-Discrimination in Health Care
Prohibits discrimination based on race, color, national origin, sex, age, or disability in certain health programs or activities. Aims to ensure fair and equal treatment in healthcare.
Flexible Spending Account Changes
Implements new regulations on flexible spending accounts, including limiting annual contributions and restrictions on qualified medical expenses. Aims for better management of reimbursable expenses.
Individual Mandate
A requirement that most Americans obtain health insurance or pay a penalty. This was intended to ensure that people don't only purchase insurance when they're sick.
Annual and Lifetime Limits
Prohibits annual and lifetime dollar limits on essential health benefits. Guarantees that patients' coverage won't run out when they need it most.
Patient-Centered Outcomes Research Institute
Funded by ACA to conduct comparative effectiveness research. The objective is to guide patients, practitioners, and policy-makers in making informed health decisions.
Rate Review
Requires health plans to justify rate increases of 10% or more before they can be implemented. Promotes accountability and moderates health care pricing.
Breastfeeding Support
Requires new private health plans to cover breastfeeding support, supplies, and counseling. Promotes maternal and child health by removing cost as a barrier to breastfeeding.
Small Business Tax Credits
Provides tax credits to small businesses offering health insurance to their employees. Intended to ease the financial burden on small businesses for providing health benefits.
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