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Affordable Care Act: How it affects you

Affordable Care Act: How it affects you

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Insurance rates -- Created a state/federal process requiring insurers to justify unreasonable premium increases.

Compare treatments -- Created an institute to do research on which medical treatments work best.

Disease prevention -- Providing $5 billion between 2010-14 and $2 billion annually thereafter for disease prevention and public health.

Medicare drug rebate -- Provided a $250 rebate to Medicare beneficiaries who reached the Part D coverage gap in 2010.

Small business credits -- Offered credits to employers with no more than 25 employees and average annual wages of less than $50,000 that provide health insurance. Over time, the credit increases to as much as 50 percent of employer cost.

Medicaid drug rebate -- Increased the drug rebate and extended it to Medicaid managed care plans.

Coordinated care for Medicaid/Medicare -- Created an office to improve care coordination for people eligible for both programs.

Non-profit hospital assessment -- Required non-profit hospitals to conduct community needs assessments and develop financial assistance policies.

Medicaid for childless adults -- States given the option to provide Medicaid coverage to childless adults with incomes up to 133 percent of the federal poverty level. (States were to be required to provide it in 2014.)

Pre-existing condition stopgap -- Temporary program provided health coverage to individuals with pre-existing medical conditions who had been uninsured for at least six months.

Consumer website -- Consumer-focused at

Coverage to age 26 -- Extended dependent coverage for adult children up to age 26.

Lifetime limits -- For new plans, it prohibited lifetime dollar limits on coverage, rescinding coverage except for fraud and denying children coverage based on pre-existing medical conditions.

Insurance appeals -- Required a process allowing consumers to appeal health plan decisions.

Preventive benefits –- Required coverage without co-pays for effective screenings and immunizations.

Health centers -- Increased funds for federally qualified health centers, such as People’s Health Center in Lincoln.

Community-based Medicaid -- New options for home and community-based services.


Insurance profits -- Provided rebates if the share of the premium spent on clinical services and quality was less than 85 percent for large group plans and 80 percent for smaller plans.

Medicare drug gap -- Drug makers must discount prescriptions (beginning with brand-name drugs) if filled in the Medicare Part D coverage gap.

Primary care pay – A 10 percent Medicare pay bonus for primary care services.

Medicare prevention -- Eliminate cost sharing for Medicare preventive services.

Innovation center -- Created a center to test new Medicare and Medicaid payment and care delivery models.

Medicare for wealthy -- Reduced Medicare Part D subsidy for those with incomes above $85,000/individual and $170,000/couple.

Medicaid homes -- Created new state option to permit Medicaid medical homes.

Non-prescription drug tax –- Eliminated the tax-free benefit for over-the-counter drugs reimbursed through various health accounts.

Wellness programs -- Gives up to 5-year grants to small employers that establish wellness programs.

Medical malpractice -- State grants to develop, implement and evaluate alternatives to current tort litigations.

Health insurance exchanges -- States receive grants to begin planning exchanges to facilitate the purchase of insurance by individuals and small employers.

Nutritional labels -- Requires disclosure of the nutritional content of standard items at chain restaurants and vending machines.

Hospital-acquired infections -- Prohibits federal pay for Medicaid services related to certain hospital-acquired infections.


ACOs -- Allows Medicare providers organized as accountable care organizations that meet quality thresholds to share in savings.

Medicare Advantage -- Reduces rebates paid to Medicare Advantage (managed care) plans and gives bonuses to quality plans.

Independence at home -- Creates a demonstration program to provide high-need Medicare beneficiaries with services in their home.

Fraud and abuse -- More oversight to find abuse of Medicare, Medicaid.

Value pay -- Bases Medicare pay to hospitals on their performance on quality measures.

Hospital readmissions -- Cuts Medicare pay to hospitals for patients whose readmissions could have been prevented.


Exchange notification -- States indicate whether they will operate an American Health Benefit Exchange.

Itemized deductions -- Increases the threshold for the itemized deduction for unreimbursed medical expenses from 7.5 percent of adjusted gross income to 10 percent of AGI.

Flexible account limits -- Limits contributions to a flexible spending account for medical expenses to $2,500 per year.

Wealth Medicare tax -- Increases the Medicare Part A (hospital insurance) tax rate on wages from 1.45 percent to 2.35 percent on earnings of more than $200,000 for individual taxpayers and $250,000 for married couples filing jointly.

Employer retiree subsidy -- Eliminates tax-deduction for employers who receive Medicare Part D retiree drug subsidy.

Medical devices tax -- Imposes an excise tax of 2.3 percent on the sale of taxable medical devices.

Financial disclosure -- Requires disclosure of relationships among physicians, hospitals, pharmacists, drug companies.

CO-OP plans -- Foster creation of non-profit, member-run health insurance companies.


Expand Medicaid -- Expands Medicaid to all individuals not eligible for Medicare under age 65 (children, pregnant women, parents and adults without dependent children) with incomes up to 133 percent of federal poverty level. (Denied by the court.)

Individual mandate -- Requires citizens and legal residents to have qualifying health coverage (there is a phased-in tax penalty for those without coverage, with certain exemptions).

Insurance exchanges -- Creates exchanges through which individuals and small businesses with up to 100 employees can purchase qualified coverage. Exchanges will have a single form for applying for health programs, including coverage through Medicaid and CHIP programs.

Subsidies -- Provides tax credits and cost sharing subsidies to eligible individuals. Premium subsidies are available to families with incomes between 133-400 percent of the federal poverty level.

Guaranteed availability -- Requires guarantee issue and renewability of health insurance regardless of health status and allows rating variation based only on age, geographic area, family composition and tobacco use.

Annual limits -- Prohibits annual limits on the dollar value of coverage.

Essential benefits -- Creates an essential health benefits package that limits annual cost-sharing to the Health Savings Account limits ($5,950/individual and $11,900/family in 2010).

Basic plan -- Permits states the option to create a Basic Health Plan for uninsured individuals with incomes between 133-200 percent of federal poverty who would otherwise be eligible to receive subsidies.

Employer fines -- A fee of $2,000 per full-time employee, excluding the first 30 employees, on employers with more than 50 employees that do not offer coverage and have at least one full-time employee who receives a premium tax credit. Larger employers will pay a penalty if they don't provide comprehensive, affordable coverage.

Advantage loss ratios -- Requires Medicare Advantage plans to have medical loss ratios no lower than 85 percent.

Wellness rewards -- Permits employers to offer employees rewards of up to 30 percent, potentially increasing to 50 percent, of the cost of coverage for participating in a wellness program and meeting certain health standards.


CHIP match -- Provides for a 23 percentage point increase in the Children’s Health Insurance Program match rate.


Choice compacts -- Permits states to form health care choice compacts and allows insurers to sell policies in any state participating in the compact.


High-cost insurance tax -- Imposes an excise tax on insurers of employer-sponsored health plans with aggregate expenses that exceed $10,200 for individual coverage and $27,500 for family coverage.


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