Health Care Reform

What is the ACA

Obama Care

3 goals of ACA

1. make affordable health insurance available to more people

2. expand the Medicaid program to cover all adults with income below 138% of the federal poverty level

3. support innovative medical care delivery methods

The 2024 poverty level for a single individual is

$15,060

how is the individual mandate satisfied?

• obtain coverage through the employer

• purchasing individual health insurance plan

• having government sponsored coverage

• a penalty for people who went without qualifying health coverage before 2019

who is exempt from individual mandate

• religious objectors

• native americans

• incarcerated individuals

• undoc immigrants

• low income (specifics)

Function of the health insurance marketplaces

provide an organized and competitive market for buying health insurance

Define State-based marketplace

• states running a state-based marketplace are responsible for performing all marketplace functions for the individual market

• consumers in these states apply for and enroll in coverage through marketplace websites established and maintained by the states

define state-based marketplace federal platform

• states are considered to have a state-based marketplace and are responsible for performing all marketplace functions for the individual market EXCEPT that the state will rely on the federal healthcare.gov website for eligibility and enrollment functions

Define federally-facilitated marketplace

• HHS performs all marketplace functions

• consumers in FFM states apply for and enroll in coverage through healthcare.gov

How did GA change in state health insurance marketplace types from 2023-2024

went from federally-facilitated marketplace to state-based marketplace federal platform

every healthcare plan must cover the following services:

• ambulatory

• emergency services

• hospitalization

• pregnancy, maternity, and newborn care

• mental health and substance use disorder

• prescription drugs

  lab services

• preventative and wellness services

What are the benefit tiers of health insurance marketplaces

• bronze

• silver

• gold

• platinum

• catastrophic

the ____ the deductible, the _____ the monthly

lower, higher

What is penalty A

no MEC offered to 95% of employees

what is penalty b

MEC is unaffordable or lacks minimal value

This example describes which penalty:

employer has 100 full-time employees but does not offer MEC to at least 95%. if 1 employee receives a tax credit, the penalty applies to 70 employees at $2,900 each

penalty A

This example describes which penalty type:

employer offers MEC to 95% but it’s unaffordable for 5 employees. Only 5 receiving tax credits are subject to the $,350 penalty each

penalty B