What should you know about healthcare reform? How can changes in the law impact you? This page offers links to resources that provide information on healthcare reform.
The Affordable Care Act
The Patient Protection and Affordable Care Act, known as the Affordable Care Act (ACA) was signed into law on March 23,
2010. The ACA contains provisions that will be implemented over the next several years. At the bottom of this page is a
table to help you better understand the ACA and its impact on healthcare practices in the United States.
View ACA Timeline
On this government Web site, you’ll find consumer-friendly information on provisions of healthcare reform law, an
implementation timeline for the Affordable Care Act, and health insurance options in your state.
Visit Web Site
Creation of Consumer Website
In July 2010, the Department of Health and Human Services created a consumer website (healthcare.gov). The website can help you identify your healthcare coverage options.
Pre-Existing Condition Plan
This is a temporary program that provides health coverage to people with pre-existing conditions. You must be uninsured for at least 6 months to be eligible. The program ends in 2014, when insurance companies can no longer deny coverage due to pre-existing conditions.
Extended Dependent Coverage
Starting in September 2010, individual and group policies began allowing adult children, up to age 26, to stay on their parents’ policies as dependent children.
Medicare Beneficiary Drug Rebate
In January 2010, individuals with Medicare Part D who reached the Part D coverage gap (aka, the “Donut Hole”) were eligible for a one-time $250 rebate. Additional financial help and discounts began in 2011.
Prohibition of Lifetime Limits
Starting on or after September 2010, health plans cannot place lifetime limits on coverage.
Coverage of Preventive Benefits
Starting on or after September 2010, health plans must cover certain benefits such as immunizations or wellness visits for children without cost-sharing.
Establish CER Entity
The Patient-Centered Outcomes Research Institute (PCORI) is established.
Changes to Tax-Free Accounts
Over-the-counter drugs will no longer be reimbursed through a Health Reimbursement Account or health Flexible Spending Account. Also, they will not be reimbursed on a tax-free basis through a Health Savings Account or Archer Medical Savings Account.
Closing the Part D Coverage GAP
For individuals with Medicare Part D, their cost-share for prescriptions filled in the Medicare Part D “donut hole” decreases. In 2011, the cost-sharing responsibility while in the donut hoe is:
By 2020, cost-sharing for all drugs in the donut-hole will decrease to 25%.
- 50% for brand name, prescription drugs
- 93% for generic prescription drugs.
Medicare Advantage Payment Changes
2011 Medicare Advantage rates are frozen at 2010 levels. Plans are prohibited from mandating higher cost-sharing levels for some Medicare benefits that are required under the traditional program.
Elimination of Cost Sharing for Full-Benefit Dual Eligibles
People enrolled in both Medicare and Medicaid ( “dual eligibles”) will no longer have copayments or coinsurance for their covered Part D drugs or for covered Part B services with visits to physicians.
Hospital-Based Value Purchasing
The law establishes a plan for Medicare to pay hospitals based on their performance. There will be pre-defined quality standards.
Accountable Care Organizations (ACOs)
Providers, organized as ACOs, may arrange inpatient and outpatient care for Medicare patients. They may share in the cost-savings this achieves.
Flex Spending Account Changes
The new provisions limit contributions to a flexible spending account to $2,500 per year.
Bundled Payment Initiative
This provision establishes a national Medicare program to develop and evaluate bundled payments for: inpatient hospital services; physician services; outpatient hospital services; and post-acute care services.
Physician Payment Disclosure Mandate ("Sunshine Act")
ACA requires manufacturers to disclose payments (for example, consulting fees, royalties, etc) or transfers of value given to healthcare providers. The disclosures will be reported on a public website.
Prohibitions of Annual Limits
Health plans will not be able to put annual limits on the dollar value of coverage.
The provision expands Medicaid eligibility to all individuals with incomes up to 133% of the federal poverty level. States have the option to expand their Medicaid programs.
State Insurance Exchanges
ACA creates a health insurance marketplace that allows patients to shop for a health plan. Plans will be offered at the state level.
Essential Health Benefits
The law creates a set of healthcare services that must be covered by most insurance plans. Also, almost all plans must phase out annual spending limits for these services.
Physician Quality Reporting System (PQRS) Penalties
Starting in 2015, penalties are sent to providers for not successfully participating in PQRS.
Independent Payment Advisory Board (IPAB)
2015 marks the first year that the IPAB can recommend Medicare payment cuts to Congress. Recommendations would be made any year the Medicare growth rate exceeds a pre-determined target. The recommendations are automatically effective unless Congress intervenes.
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