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4/ accessHealthnews.net Summer 2013 ACA Timeline Health care reform from 2010 to 2018 accessHealth Staff 2014 2010 2011 Patients' Bill of Rights ● Children under 19 can't be denied health insurance because of a pre-existing condition. ● The Pre-Existing Condition Insurance Plan (PCIP) begins offering temporary insurance to people who have been denied coverage. ● Young adults up to age 26 can remain on their family's health insurance plan. ● Individuals with new group plans or private insurance do not have to pay out-ofpocket costs for certain preventive care services. ● Insurance companies can no longer place lifetime dollar limits on health coverage, or drop your coverage if you get sick. Medicare enhancements Seniors who reach the coverage gap (donut hole) will receive a 50% discount when buying Medicare Part D covered brand name prescription drugs. Over the next 10 years, seniors will receive additional savings on generic and brand name drugs until the coverage gap is closed in 2020. Preventive services, like annual wellness visits and personalized prevention plans are provided at no cost. Marketplace begins offering health insurance If an employer doesn't offer insurance, it can be purchased directly through the Health Insurance Marketplace. Individuals and small businesses will have a choice of health plans that meet certain benefits and cost standards. Members of Congress will also purchase health care insurance through Marketplace. 2012 the Payments linked to outcomes ACA established a Value-Based Health insurance is required Purchasing (VBP) program in in order to avoid a penalty traditional Medicare. Hospitals Under the law, individuals who receive financial incentives to can afford it will be required to improve quality of care. obtain basic health insurance Performance must be publicly coverage or pay a fee. If reported for conditions like heart affordable coverage is not attacks, heart failure, available to an individual, he or pneumonia, surgical care, health she will be eligible for an care-associated infections and exemption. (Effective January 1) patient perception of care. Tax credits offered to reduce Accountable Care cost of premiums Tax credits will be available to Organizations (ACOs) The law provides incentives for offset costs for incomes between physicians to form ACOs to 100% and 400% of the poverty coordinate patient care, improve level and are not eligible for affordable coverage. quality, help prevent disease and other Some individuals may also illness, and reduce hospital admissions. ACOs, with proven qualify for reduced cost-sharing cost reduction, will keep some of like, co-payments, co-insurance, and deductibles. (Effective the money they help save. January 1) Medicare Advantage Plans Payments are reduced to Medicare Advantage Plan insurance companies. People enrolled in Medicare Advantage will see no change in their plans and still receive all guaranteed Electronic Health Records Small business health benefits. (EHRs) insurance tax credits Small businesses are eligible for Improved care for seniors Standardized billing is introduced tax credits for employee health after they leave the hospital and health plans must begin insurance. Tax credits are up to The Community Care Transition adopting and implementing rules helps high risk for secure, confidential, 35% of the employer's Program contribution. In 2014, tax credits Medicare beneficiaries, who are electronic exchange of health increase up to 50%. Small hospitalized, avoid unnecessary information. EHR use is expected nonprofit organizations receive readmissions by coordinating to reduce paperwork, medical up to 25% with an increase next care and connecting patients to errors and improve quality of services in their communities. care. year of up to 35%. Early Retiree Reinsurance Program (ERRP) ACA authorized $5 billion for ERRP to preserve employer coverage for early retirees until the Health Insurance Marketplace is available in January 2014. The program provides financial help for the continuation of employer-based plans for people who retire between ages 55-65. Spouses and dependents are also covered. Pre-Existing Condition Insurance Plan (PCIP) New coverage options provided to individuals who have been uninsured for at least six months due to a pre-existing condition. Consumer rebates ACA requires at least 80% of all premium dollars be spent on health care services and quality improvement. For plans sold to individuals and small employers, at least 80% of the premium must be spent on health benefits and quality improvement. If insurance companies do not meet these guidelines, they must pay rebates to customers. Community First Choice Option The program allows states to offer home- and communitybased services to disabled individuals through Medicaid rather than institutional care in nursing homes. 2013 Medicaid payments for primary care doctors increase As Medicaid programs and providers prepare to cover more patients in 2014, ACA requires states to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government. Small business tax credit increases Qualified small businesses receive up to a 50% credit for employer contributions to employee health plans. Small nonprofits receive up to a 35% credit. Other reforms in 2014 Insurance companies can no longer deny coverage based on a pre-existing condition or due to gender. Annual limits on insurance coverage are eliminated. 2015 Physicians paid on value Physician payments are tied to the quality of care provided. Payments will be modified so that those who provide higher value care will receive higher payments than those who Open enrollment: Health provide lower quality care. Insurance Marketplace 2018 Individuals and small businesses "Cadillac" employee plans can buy "affordable" insurance from qualified health insurance Plans that cost more than $10,200 a year for individuals plans beginning October 1. or $27,500 for family coverage are subject to a 40% tax.

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