Download or read book Health Insurance Exchanges Under the Patient Protection and Affordable Care Act ACA written by Bernadette Fernandez and published by Createspace Independent Pub. This book was released on 2012-10-20 with total page 40 pages. Available in PDF, EPUB and Kindle. Book excerpt: The fundamental purpose of a health insurance exchange is to provide a structured marketplace for the sale and purchase of health insurance. The authority and responsibilities of an exchange may vary, depending on statutory or other requirements for its establishment and structure. The Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) requires health insurance exchanges to be established in every state by January 1, 2014. ACA provides certain requirements for the establishment of exchanges, while leaving other choices to be made by the states. Qualified individuals and small businesses will be able to purchase private health insurance through exchanges. Issuers selling health insurance plans through an exchange will have to follow certain rules, such as meeting the private market reform requirements in ACA. While the fundamental purpose of the exchanges will be to facilitate the offer and purchase of health insurance, nothing in the law prohibits qualified individuals, qualified employers, and insurance carriers from participating in the health insurance market outside of exchanges. Moreover, ACA explicitly states that enrollment in exchanges is voluntary and no individual may be compelled to enroll in exchange coverage. Exchanges may be established either by the state itself as a “state exchange” or by the Secretary of Health and Human Services (HHS) as a “federally facilitated exchange.” All exchanges are required to carry out many of the same functions and adhere to many of the same standards, although there are important differences between the types of exchanges. States will need to declare their intentions to establish their own exchanges by no later than November 16, 2012. ACA and regulations require exchanges to carry out a number of different functions. The primary functions relate to determining eligibility and enrolling individuals in appropriate plans, plan management, consumer assistance and accountability, and financial management. ACA gives various federal agencies, primarily HHS, responsibilities relating to the general operation of exchanges. Federal agencies are generally responsible for promulgating regulations, creating criteria and systems, and awarding grants to states to help them create and implement exchanges. A state that is approved to operate its own exchange has a number of operational decisions to make, including decisions related to organizational structure (governmental agency or a nonprofit entity); types of exchanges (separate individual and Small Business Health Options Program (SHOP) exchanges, or a merged exchange); collaboration (a state may independently operate an exchange or enter into contracts with other states); service area (a state may establish one or more subsidiary exchanges in the state if each exchange serves a geographically distinct area and meets certain size requirements); contracted services (an exchange may contract with certain entities to carry out one or more responsibilities of the exchange); and governance (governing board and standards of conduct). In general, health plans offered through exchanges will provide comprehensive coverage and meet all applicable private market reforms specified in ACA. Most exchange plans will provide coverage for “essential health benefits,” at minimum; be subject to certain limits on cost-sharing, including out-of-pocket costs; and meet one of four levels of plan generosity based on actuarial value. To make exchange coverage more affordable, certain individuals will receive premium assistance in the form of federal tax credits. Moreover, some recipients of premium credits may also receive subsidies toward cost-sharing expenses.
Download or read book Health Insurance Exchanges Under the Patient Protection and Affordable Care Act ACA written by and published by . This book was released on 2012 with total page 34 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Health Insurance Exchanges Under the Affordable Care Act written by Edward J. Volpicelli and published by Nova Science Publishers. This book was released on 2013 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The fundamental purpose of a health insurance exchange is to provide a structured marketplace for the sale and purchase of health insurance. The authority and responsibilities of an exchange may vary, depending on statutory or other requirements for its establishment and structure. The Patient Protection and Affordable Care Act (ACA) requires health insurance exchanges to be established in every state by January 1, 2014. ACA provides certain requirements for the establishment of exchanges, while leaving other choices to be made by the states. This book outlines the required minimum functions of exchanges, and explains how exchanges are expected to be established and administered under ACA. The coverage offered through exchanges is discussed, as are how the exchanges will interact with selected other ACA provisions.
Download or read book Section 1557 of the Affordable Care Act written by American Dental Association and published by American Dental Association. This book was released on 2017-05-24 with total page 60 pages. Available in PDF, EPUB and Kindle. Book excerpt: Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). This brief guide explains Section 1557 in more detail and what your practice needs to do to meet the requirements of this federal law. Includes sample notices of nondiscrimination, as well as taglines translated for the top 15 languages by state.
Download or read book Health Care Utilization as a Proxy in Disability Determination written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2018-04-02 with total page 161 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
Download or read book Overview of Health Insurance Exchanges written by Congressional Service and published by Createspace Independent Publishing Platform. This book was released on 2018-07-04 with total page 26 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) requires health insurance exchanges to be established in every state. Exchanges are marketplaces in which consumers and small businesses can shop for and purchase private health insurance coverage. In general, states must have two types of exchanges: an individual exchange and a small business health options program (SHOP) exchange. Exchanges may be established either by the state itself as a state-based exchange (SBE) or by the Secretary of Health and Human Services (HHS) as a federally facilitated exchange (FFE). Some states have SBE-FPs: they have SBEs but use the federal information technology platform, including the federal exchange website www.Healthcare.gov. In states with FFEs, the exchange may be operated by the federal government alone or in conjunction with the state. States may have different structures for their individual and SHOP exchanges. Consumers who obtain coverage through the individual exchange may be eligible for financial assistance from the federal government. Financial assistance in the individual exchanges is available in two forms: premium tax credits and cost-sharing reductions. Small businesses that use the SHOP exchange may be eligible for small business health insurance tax credits. The tax credits assist small businesses with the cost of providing health insurance coverage to employees. The ACA generally requires that health insurance plans offered through an exchange are qualified health plans (QHPs). To be a certified as a QHP, a plan must be offered by a state-licensed issuer and must meet specified requirements, including covering the essential health benefits (EHB). QHPs sold in the individual and SHOP exchanges must comply with the same state and federal requirements that apply to QHPs and other health plans offered outside of the exchanges in the individual and small-group markets, respectively. Exchanges also may offer variations of QHPs, such as child-only or catastrophic plans, and non-QHP dental-only plans. This report provides an overview of the various components of the health insurance exchanges. It begins with summary information about how exchanges are structured and then discusses both individual and SHOP exchanges in terms of eligibility and enrollment, financial assistance for certain exchange consumers and small businesses, and enrollment assistance entities. The report also describes exchanges' role in certifying plans as qualified to be sold in their marketplaces and outlines the range of plans offered through exchanges. Finally, the report briefly addresses funding for the exchanges.
Download or read book Health Insurance Exchanges written by Suzanne M. Kirchhoff and published by CreateSpace. This book was released on 2015-06-26 with total page 36 pages. Available in PDF, EPUB and Kindle. Book excerpt: The 2010 Patient Protection and Affordable Care Act (ACA, P.L. 111-148) allows certain individuals and small businesses to buy qualified health insurance through state exchanges. The exchanges are not themselves insurers, but rather are special marketplaces where insurance firms may sell health policies that meet set, federal guidelines. As of July 2014, 14 states and the District of Columbia had secured HHS approval to create and run their own exchanges, 7 to enter into partnership exchanges, 29 to have federally facilitated exchanges, and two to have state-based SHOP/federally facilitated individual exchanges. An estimated 25 million individuals are expected to secure coverage through the exchanges by 2024.
Download or read book Health Insurance Exchanges Premium Tax Credits and Changes to Health Plans written by Elliot Carpenter and published by Nova Snova. This book was released on 2020-03-03 with total page 254 pages. Available in PDF, EPUB and Kindle. Book excerpt: Since 2014, millions of individuals have purchased coverage through the health insurance exchanges established under Patient Protection and Affordable Care Act (PPACA). PPACA altered the individual health insurance market by setting federal standards for coverage and subsidizing exchange coverage for certain low-income individuals. In the first 5 years of exchanges, issuers have moved in and out of the market and increased premiums, but little is known about issuers' claims costs or the factors driving their business decisions. Chapter 1 examines (1) claims costs of issuers participating in exchanges, and (2) factors driving selected issuers' changes in exchange participation, premiums, and plan design. GAO reviewed data from nine issuers participating in five states, which were selected to represent a range in size, tax status, and exchange participation. During open enrollment, eligible returning consumers may re-enroll in their existing health insurance exchange plan or choose a different plan. Those who do not actively enroll in a plan may be automatically re-enrolled into a plan. Chapter 2 examines 1) the extent to which plans identified as benchmark plans remained the same plans from year to year, and how premiums for benchmark plans changed; 2) the proportion of exchange consumers who were automatically re-enrolled into the same or similar plans, and how these proportions compared to those for consumers who actively re-enrolled, and 3) the extent to which consumers' financial responsibility for premiums changed for those who were automatically re-enrolled compared to those who actively re-enrolled. Chapter 3 discussed the amendments to title XIX of the Social Security Act to ensure health insurance coverage continuity for former foster youth. Certain individuals without access to subsidized health insurance coverage may be eligible for premium tax credits, as established under the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended). The dollar amount of the premium credit varies from individual to individual, based on a formula specified in statute. Individuals who are eligible for the premium credit, however, generally are still required to contribute some amount toward the purchase of health insurance as described in chapter 4. During the summer of 2018, the Trump Administration issued final rules governing coverage offered through association health plans (AHPs) and short-term, limited-duration insurance. Chapter 5 describes how the Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) analyzed the new rules and determined how those rules would affect the agencies' projections of the number of people who obtain health insurance and the costs of federal subsidies for that coverage.
Download or read book Designing an Exchange written by and published by . This book was released on 2011 with total page 45 pages. Available in PDF, EPUB and Kindle. Book excerpt: This National Academy of Social Insurance (NASI) legislative toolkit will assist states with the design of health insurance exchanges, an important feature of the Patient Protection and Affordable Care Act (ACA). How states design and implement health insurance exchanges will matter in achieving ACA's coverage, quality, and efficiency goals. The NASI toolkit, funded by the Robert Wood Johnson Foundation, provides technical assistance to states in a number of key areas such as governance; establishment of Small Business Health Options Program (SHOP) exchanges for small employers; eligibility determination and enrollment; certification of qualified health plans; and coordination with Medicaid and the Children's Health Insurance Program.
Download or read book Patient Protection and Affordable Care Act written by Congressional Research Service and published by Createspace Independent Publishing Platform. This book was released on 2017-04-07 with total page 38 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) has numerous provisions affecting private health insurance and public health coverage programs. This report provides resources to help congressional staff respond to constituents' frequently asked questions (FAQs) about the law. The report lists selected resources regarding consumers, employers, and other stakeholders, with a focus on federal sources. It also lists CRS reports that summarize the ACA's provisions. The report begins with links to contacts for constituents' specific questions on insurance coverage (such as state insurance departments and the U.S. Department of Labor's consumer hotline for questions on employer-based coverage), and contacts for questions about HealthCare.gov and ACA tax provisions. The report also lists sources for congressional staff to contact federal agencies with ACA questions. The report provides basic consumer sources, including a glossary of health coverage terms. The next sections focus on the individual mandate, private health insurance, exchanges, and employer-sponsored coverage. These are followed by information on public health care programs, such as Medicaid and the State Children's Health Insurance Program (CHIP) and Medicare. The report also provides sources on the ACA's provisions on specific populations: women's health care, Indian health care, veterans' and military health care, and the treatment of noncitizens under the ACA. These are followed by sources on behavioral health (mental health and substance use disorders); public health, workforce, and quality; and state innovation waivers. Finally, the report lists sources on taxes, congressional efforts to repeal or amend ACA, ACA agency audits and investigations, cost estimates and spending, insurance coverage statistics, legal issues, and sources for obtaining the law's full text. This list is not a comprehensive directory of all resources on the ACA but rather is intended to address some questions that may arise frequently.
Download or read book Health Insurance Exchanges and the Assistance Role of Navigators written by Wallace V. Bremer and published by Nova Science Publishers. This book was released on 2013 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The fundamental purpose of a health insurance exchange is to provide a structured marketplace for the sale and purchase of health insurance. The authority and responsibilities of an exchange may vary, depending on statutory or other requirements for its establishment and structure. The Patient Protection and Affordable Care Act requires health insurance exchanges to be established in every state by January 1, 2014. The ACA provides certain requirements for the establishment of exchanges, while leaving other choices to be made by the states. Qualified individuals and small businesses will be able to purchase private health insurance through exchanges. Issuers selling health insurance plans through an exchange will have to follow certain rules, such as meeting the private market reform requirements in the ACA. While the fundamental purpose of the exchanges will be to facilitate the offer and purchase of health insurance, nothing in the ACA prohibits qualified individuals, qualified employers, and insurance carriers from participating in the health insurance market outside of exchanges. This book outlines the required minimum functions of exchanges, and explains how exchanges are expected to be established and administered under the ACA. The coverage offered through exchanges is discussed, and the book concludes with a discussion of how exchanges will interact with selected other ACA provisions.
Download or read book Establishing California s Health Insurance Exchange Under the Affordable Care Act Governance and Operating Model written by Charlaine Myshelle Hamilton and published by . This book was released on 2011 with total page 128 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Patient Protection and Affordable Care Act (ACA) requires states to establish health insurance exchanges to facilitate the purchase of qualified health care coverage. The ACA affords states flexibility in designing these exchanges. This thesis is an analysis of the alternatives for the governance and operating model of an exchange in California. Within the parameters of the ACA, I present four alternatives for the exchange governance and three alternatives for its operating model. I then compare the alternatives based on how well they avoid adverse selection, facilitate competition, and provide an enhanced consumer experience. The results showed that establishing an independent government agency that selectively contracts with participating health insurers is the optimal choice for California.
Download or read book The Impacts of the Affordable Care Act on Preparedness Resources and Programs written by Institute of Medicine and published by . This book was released on 2014 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Many of the elements of the Affordable Care Act (ACA) went into effect in 2014, and with the establishment of many new rules and regulations, there will continue to be significant changes to the United States health care system. It is not clear what impact these changes will have on medical and public health preparedness programs around the country. Although there has been tremendous progress since 2005 and Hurricane Katrina, there is still a long way to go to ensure the health security of the Country. There is a commonly held notion that preparedness is separate and distinct from everyday operations, and that it only affects emergency departments. But time and time again, catastrophic events challenge the entire health care system, from acute care and emergency medical services down to the public health and community clinic level, and the lack of preparedness of one part of the system places preventable stress on other components. The implementation of the ACA provides the opportunity to consider how to incorporate preparedness into all aspects of the health care system. The Impacts of the Affordable Care Act on Preparedness Resources and Programs is the summary of a workshop convened by the Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events in November 2013 to discuss how changes to the health system as a result of the ACA might impact medical and public health preparedness programs across the nation. This report discusses challenges and benefits of the Affordable Care Act to disaster preparedness and response efforts around the country and considers how changes to payment and reimbursement models will present opportunities and challenges to strengthen disaster preparedness and response capacities.
Download or read book Medicaid and Health Insurance Exchanges written by Scott Ahearn and published by Nova Science Publishers. This book was released on 2013 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Patient Protection and Affordable Care Act (ACA) expands health insurance coverage primarily through two mechanisms: by expanding the existing Medicaid program and by establishing new health insurance exchanges where certain individuals and businesses can purchase private health insurance. Under ACA, Medicaid and exchanges are envisioned to work in tandem, with the potential to provide a continuous source of subsidised coverage for lower-income individuals and families, beginning in 2014. This book provides an analysis of some of the key similarities and differences between Medicaid and insurance plan structure in plans offered through exchanges. Because Medicaid services vary by population covered and by state, and exchange plans can also vary by state, this book provides insight into the complexities and issues when comparing beneficiary benefits and costs to individuals for Medicaid and the exchanges. The inherent variations in Medicaid and the uncertainty about exactly how the exchanges will operate are just two of the factors that complicate this comparison.
Download or read book Health Insurance Exchanges and the Affordable Care Act written by Timothy S. Jost and published by . This book was released on 2010 with total page 64 pages. Available in PDF, EPUB and Kindle. Book excerpt: The state-level health insurance exchanges to be created under the Affordable Care Act (ACA) are expected to play a major role in the purchase and sale of health insurance when they become fully operational in 2014. This report focuses on eight of the most difficult issues that the states and the federal government face in implementing the exchanges: governance of the exchanges; avoidance of adverse selection; making self-funded plans compatible with exchanges; making exchanges attractive to employers; exchanges' use of their regulatory authority; determining the information that exchanges must make available to consumers and employers; the exchanges' role in making eligibility determinations for premium tax credits and cost-sharing reduction payments and their relationship with public insurance programs; and reducing administrative costs. The report also examines how the ACA handles those issues, and makes concrete recommendations as to how those issues should be addressed.
Download or read book Appropriations and Fund Transfers in the Affordable Care ACT ACA written by Congressional Research Service and published by CreateSpace. This book was released on 2015-06-26 with total page 32 pages. Available in PDF, EPUB and Kindle. Book excerpt: Implementation of the Patient Protection and Affordable Care Act (Affordable Care Act, or ACA) is having a significant impact on federal mandatory-also known as direct-spending. Most of the projected spending under the law is for expanding health insurance coverage. This spending includes premium tax credits and other subsidies for individuals and families that purchase private insurance coverage through the health insurance exchanges established under the ACA, as well as enhanced federal funding to expand state Medicaid programs and tax credits for small employers.
Download or read book Affordable Care Act written by Sean R. Abernathy and published by Nova Science Publishers. This book was released on 2014 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Congress is deeply divided over implementation of the Patient Protection and Affordable Care Act (ACA). Since the ACA's enactment, lawmakers opposed to specific provisions in the ACA, or to the entire law, have debated implementation of the law on numerous occasions and considered multiple bills to repeal, defund, delay, or otherwise amend the law. Topics discussed in this compilation include the legislative actions to repeal, defund, or delay the Affordable Care Act; health insurance exchanges under the patient protection and ACA; health insurance premium credits in the patient protection and ACA; physician supply; annual fees on health insurers; and medical loss ratio requirements under the patient protection and ACA.
