April 2016 FAQ
The U.S. Department of Labor issued “FAQs about Affordable Care Act Implementation (Part 31)” on April 20, 2016. Question 8 stated:
Q8. “When performing “substantially all” and “predominant” tests for financial requirements and quantitative treatment limitations under MHPAEA, may a plan or issuer base the analysis on an issuer’s entire overall book of business for the year”?
The answer was quite a surprise to most actuaries that perform MHPAEA compliance testing:
“No. Basing the analysis on an issuer’s entire overall book of business expected to be paid for the year or book of business in a specific region or State is not a reasonable method to determine the dollar amount of all plan payments under MHPAEA. To the extent group health plan-specific data is available, each self-insured group health plan must use such data in making their projections. For large fully-insured group health plans, for which the premiums are determined on an experience-rated basis, the issuer should generally have group health plan-specific data to make projections. If a large, fully-insured plan does not have sufficient group health plan-specific data to make projections, data from other similarly-structured group health plans with similar demographics can be utilized for the analysis.
For insured small group and individual market plans, the health insurance issuer should use data at the “plan” level (as opposed to the “product” level) to perform the substantially all and
In order to make insurance affordable to all there were extensive private health insurance regulatory reforms, particularly in the small group and non-group markets, there were tax credits offered to the smallest lowest-wage employers for the purchase of health insurance, there were reductions in cost-sharing associated with recommended preventive care. For example if you signed up with a fitness center you can get a 50% discount on your insurance. The market exchange was established for the purchase of private coverage plus subsidies for the individual purchase of coverage and for the cost-sharing of the modest income. “The affordable care act also expanded the eligibility for the Medicaid program to all non-elderly with incomes up to 138 percent of the federal poverty level ($23,000 to $32,000 for a family of four in 2012) starting in 2014, which helped phase out the Medicare prescription drug benefit coverage gap, a.k.a. the “doughnut hole”.” To make sure that everyone is complying with the rule of everyone needs to have healthcare coverage there was a penalty set up for those that failed to comply. The penalty was if you did not have insurance by the set date you will receive a tax penalty that you will have to pay when filling your taxes. There are financial requirements that large- and medium sized
The Patient Protection and Affordable Care Act of 2010 is a law that altogether changed healthcare in the United States. It made protection accessible to between 32 million and 50 million more Americans, or 95 percent of the lawful population. The Act, also referred to as Obamacare, was marked into law on March 3, 2010. It was staged in more than four years. Each citizen was required to have medical coverage by March 31, 2014, or confront a salary impose extra charge. In case they starting at now have a plan, paying little respect to whether through their supervisors, Medicaid, Medicare, or secretly keep it. The people who couldn't get medicinal scope have additional options. They can get it from a therapeutic scope exchange and conceivably
As of September 23, 2012 or soon after, health insurance issuers and group health plans are required to provide you with an easy to understand summary about a health plan’s benefits and coverage. The new regulation is designed to help you better understand and evaluate
Blumenthal, D., & Collins, S. (2014, July 17). Health Care Coverage under the Affordable Care Act — a progress report. The New England Journal of Medicine, 275-281. http://dx.doi.org/10.1056/NEJMhpr1405667
The Affordable Care Act (ACA) extended healthcare coverage to millions of formerly uninsured individuals by expanding eligibility of Medicaid and the formation of Health Insurance Marketplaces. The ACA also included reforms to assist individuals sustain coverage and have the availability of affordable and accessible private healthcare insurance. Analysis from 2014 and early 2015 and have shown significant increases in public and private healthcare insurance coverage and have attributed the remarkable decreases of the rates of uninsured individuals from marketplace.gov and health insurance exchanges from the first year the ACA had healthcare coverage available.
The Affordable Care Act was signed into law early spring of 2010. It’s probably the most comprehensive reform we’ve seen in the United States healthcare system within the last forty four years. Although the law was put into effect, the features of the new law took effect in 2014. The Affordable Care Act changed the non insurance group market in the United States, mandates most residents to have health insurance, considerably expand public insurance and subsidize private insurance, while raising revenue from a variety of new taxes. Projecting the impacts of the health care system will be challenging, but related estimates were required for the legislative process, and conducted by the Congressional Budget Office.
The Affordable Care Act was signed into law in 2010, just over five years ago. Since then the healthcare industry, and even organizations outside the industry, have been affected in many ways; from new reimbursement models, opening healthcare exchanges, millions of individuals gaining insurance that they previously did not have, and a plethora of new regulations just to name a few. Although the law was passed in 2010, it wasn’t until 2014 that millions of newly insured participants entered into the system when much of the affects were initially recognized. However, even with two enrollment periods under our belt, a new enrollment period set to begin in a month, along with additional regulations still to be fully recognized, how the
The affordable care act truly contains over a thousand pages of reforms to the insurance and health care industries in order to combat rising health care costs that are manifesting all around the country. Throughout the developing statistics pertaining to the American that did not receive health care insurance, it was stated that as of 2013 there were close to around 44 million Americans who went without health insurance, this can be a little less than sixteen percent of the United States population (Cite). So let’s take a look at the majority of those individuals that are unisured, they
For those Americans not covered or find their work coverage too expensive, there is a new way for them to buy insurance on their own called Health Insurance Marketplaces. Some states have named these marketplaces something else. The Health Insurance Marketplace is like a virtual insurance megamall where private insurers compete for American’s business. Americans can pick out how much coverage they want, how much they want to pay for it, from cheaper high deductible plans to more expensive plans. Regardless what plan is chosen, all plans will cover a complete set of services like hospital visits, doctor visits,
On September 17, 2009, President Barack Obama proposed a new plan for healthcare, known as the Affordable Care Act, and on March 23, 2010, the new plan was signed into law, making health insurance a requirement (United States Department of Health and Human Services). The Affordable Care Act was proposed with the intent to lower the costs of health care, making it more available to everyone. The law also aims to improve coverage and prohibit insurance companies from dropping customers or denying coverage to people with pre-existing health conditions. The Affordable Care Act requires almost every U.S. citizen to either seek coverage or pay a fine. The law expands Medicaid in an effort to help the uninsured become insured as well. At first,
The Affordable Care Act (Patient Protection and Affordable Care Act), commonly called "Obamacare," is a federal statute that was signed into law in March of 2010 (PDF, n.d.; Van de Water, 2011). It basically requires the vast majority of people in the United States who do not have insurance coverage to acquire that coverage or face penalties. People who already have insurance through their employers or on their own will not be asked to change companies. Additionally, anyone who is on federally-funded insurance such as Medicaid or Medicare and still qualifies for those programs will not be removed from their insurance. They will still be covered and protected. In order to find out more about the Act and really understand its main points and principles, however, it is very important to be aware of how it became a law and any changes that have taken place to it from its inception all the way through where it is today. Only then can a person have a clear understanding of the Act and form an opinion as to the value it may (or may not) provide to the American public. There is still much speculation and a great deal of misunderstanding about the Act and what it involves.
Since the implementation of the Affordable Care Act, some may argue that access to quality health care and services are easier to obtain. The law mandates that all citizens of the United States as well as those individuals who are non-citizens, but are legal residents, acquire health insurance coverage. In order for there to be minimal barriers to accessibility of health coverage, an online health insurance marketplace provides individuals with the option to shop for health insurance plans. The plans are categorized by the state in which the individual resides. The exchange allows individuals to review plan specifications. Additionally, the exchange provides coverage options through participating insurers through a tier system. The consumer is able to make a comparison of services covered in each tier, prescription costs, as well as premium costs associated with each health plan. From that, consumers have information about an array of detailed plan options and covered services in which to make an informed decision and purchase coverage that best suits their individual needs as well as the needs of their family.
The Affordable Care Act, also called the ACA or Obamacare, is a health care reform law in America. The Affordable Care Act is a long, complex piece of legislation that attempts to reform the healthcare system by providing more Americans with affordable quality health insurance and by curbing the growth in healthcare spending. The law includes new benefits, rights, and protections, rules for Insurance Companies, taxes, tax breaks, funding, spending, and the creation of committees, education, new job creation, and more. The ACA includes 10 titles that address reform the U.S. healthcare system. Some of the provisions include eliminating lifetime and unreasonable annual limits on benefits. It mandates that EHB (or essential health benefits) must be included on all new plans. These benefits include ambulatory services, emergency care, hospitalization, maternity and newborn care, prescription drugs, mental health and substance abuse services, rehabilitative services and devices, labs, chronic disease management and oral and vision care for children. The new law prevents individuals from being dropped from their coverage for any reason other than fraud. The ACA requires coverage of preventative services and immunizations and of dependents up to the age of 26 years old. The law also provides assistance for individuals with preexisting conditions. The ACA also caps insurances companies’ non-medical and
The ACA requires insurers to accept all applicants, cover certain conditions, and charge the same rates despite one 's sex or pre-existing health status. There are ten provisions that make up the ACA which were to be implemented over time, from 2010 through 2020. The first provision is individual insurance, which prohibits insurers to deny coverage based on one 's pre existing health conditions. States were also required to make insurance available to children who are not insured through their families. Medicaid was also expanded to include individuals and families with an average income of thirty thousand dollars a year. This mandate will not cover those who are illegal immigrants, eligible individuals who choose to not be enrolled in medicaid, those who choose to pay the penalty, individuals whose insurance would cost more than 8% of their income, and those who live in states that opt out of the medicaid expansion.
The Federal Employee Health benefit program is the largest employer health insurance program in the United States, insuring about 3 percent of all Americans. There are 133 plans, offering 188 coverage options that are participating in the FEHBP as of 2003. Preferred provider organization (PPO), fee-for-service plans, and Health Maintenance Organization (HMO) all offer options. The government’s contribution toward the cost of the beneficiary’s premium is “lesser of 72 percent of the average FEHBP plan premium, weighted by enrollment, or 75 percent of the premium for the plan chosen” (Karen Davis) .