Affordable Care Act Vocabulary Flashcards

These flashcards cover key vocabulary related to the Affordable Care Act, its provisions, and associated health care concepts.

Affordable Care Act (ACA)

A comprehensive health care reform law enacted in March 2010 aimed at expanding access to health insurance and reducing costs.

Medicaid Expansion

A provision of the ACA that allows states to expand Medicaid coverage to individuals with incomes up to 138% of the federal poverty level.

Health Insurance Exchanges

Online marketplaces where individuals and small businesses can purchase health insurance plans; also known as health insurance marketplaces.

Premium Tax Credits

Subsidies provided under the ACA to help individuals and families with incomes between 100% and 400% of the federal poverty level pay for health insurance premiums.

Essential Health Benefits (EHBs)

A set of health care service categories that must be covered by certain plans, including ambulatory patient services, emergency services, hospitalization, and more.

Subsidies

Financial assistance provided to help lower costs of health insurance premiums for eligible individuals and families.

Guaranteed Issue

A provision that requires insurance companies to sell policies to all applicants, regardless of health status.

Cost-Sharing Reductions (CSRs)

Discounts that lower the amount you have to pay for deductibles, copayments, and coinsurance in health insurance coverage.

Federal Poverty Level (FPL)

A measure used to determine eligibility for certain programs, including Medicaid and tax credits under the ACA.

Actuarial Value

A measure of the percentage of health care expenses that a health plan will cover, classified into tiers: Bronze, Silver, Gold, and Platinum.

National Federation of Independent Business (NFIB) v. Sebelius

A landmark Supreme Court case that upheld the ACA's individual mandate and clarified that states cannot be compelled to expand Medicaid.

Marketplace Subsidies

Financial assistance available through ACA exchanges to help individuals lower their premium costs.

Community Rating

A price-setting mechanism used in health insurance that limits how much premiums can vary based on factors like age, geography, and tobacco use.

Open Enrollment Periods

Specific periods during which individuals can enroll in health insurance plans or make changes to their coverage.

Preexisting Conditions

Medical conditions that existed before the start of a new health insurance policy, which cannot be used to deny coverage under the ACA.

Federal Match Rate

The percentage of Medicaid program costs covered by the federal government, which increased with ACA Medicaid expansion.

Health Insurance Marketplaces

A platform, created by the ACA, for individuals to compare and purchase health insurance plans.

Emergency Services

Health care services that are essential for the treatment of emergency medical conditions and must be covered by health plans under the ACA.

Family Size

The number of people in a household, which can affect eligibility and cost calculations for health insurance.

Mental Health Services

Health care services aimed at treating mental health disorders, which are included as essential health benefits under the ACA.

Preventative Services

Health care services aimed at preventing illnesses or detecting them early, which must be covered without cost-sharing under the ACA.

Marketplace Premiums

Monthly costs that individuals must pay to maintain their health insurance coverage obtained through the ACA marketplace.

Chronic Condition Management

Programs designed to help individuals manage chronic health issues, which fall under essential health benefits.

Rehabilitative Services

Health care services that help patients regain skills or functioning lost due to injury or illness, covered under the ACA.

Tobacco Use Rating

A provision allowing insurers to charge higher premiums based on an individual’s tobacco use under certain conditions.

Silver Plan

A type of health insurance plan on the ACA marketplace, offering moderate premiums and benefits.

Discrimination on Health Status

A practice prohibited by the ACA, preventing insurers from charging different rates or denying coverage based on an individual's health.

Financial Barriers

Obstacles that individuals face when attempting to pay for health care, including high costs of premiums and out-of-pocket expenses.

Health Coverage Gap

The coverage gap for adults in states that did not expand Medicaid, leaving many without affordable health insurance options.

Inflation Reduction Act

Legislation affecting premium tax credits eligibility under the ACA, temporarily allowing individuals at 100% FPL and up to qualify.

Essential Health Benefits Categories

Ten categories of services that health insurance plans must cover, including maternity care, prescription drugs, and pediatric services.

Cost of Care

The total expenses incurred for health services, including premiums, deductibles, and other out-of-pocket costs.