1. Patient Protection and Affordable Care Act of 2010

2. Glossary of Terms

3. Glossary of Terms
Affordable Care Act (ACA) (Public Law ) – the ACA was implemented on March 23, and is intended to increase access to health care for more Americans, and includes many changes that impact the commercial health insurance market, Medicare, and Medicaid. ACA is also referred to as the “health reform act” or “Patient Protection Affordable Care Act (PPACA)”

4. Glossary of Terms
Accountable Care Organization (ACO) – these organizations provide the full range of health care services.
Adjusted Community Rating – a way of pricing insurance where premiums are not based upon a policyholder’s health status, but may be based upon other factors, such as age and geographic location

5. Glossary of Terms
Annual Benefit Limit – the maximum amount your plan will pay in a calendar year
Balance Billing – balance billing occurs when a provider bills you for the difference between his charge and the allowed amount
Benefit Package – the set of health services, such as physician visits, hospitalizations, and prescription drugs, which are covered by your health plan

6. Glossary of Terms
Community Rating – a method of pricing health plans, where all insureds are charged the same premium, regardless of health status, age or other factors
Co-Op Plan – a health plan that will be sold by member-owned and operated non-profit organizations through Exchanges open in 2014

7. Glossary of Terms
Employer Mandate – beginning in 2014, employers meeting the size or revenue thresholds will be required to offer minimum essential health benefit packages or pay a set portion of the cost of those benefits for use in the Exchanges
Essential Health Benefits – general categories of benefits as defined by the ACA that must be included in a qualified health plan, effective 1/1/2014

8. Glossary of Terms
Exchange or Health Insurance Exchange – the ACA requires each state to create a Health Benefit Exchange (competitive insurance marketplace), where individuals and small employers can shop for health plans. Exchanges will assist individuals and small businesses in comparing and purchasing qualified health plans. If a state decides not to establish an Exchange, the federal government will establish an Exchange in that state

9. Glossary of Terms
Federal Poverty Level (FPL) – the FPL is set at $22,350 total yearly income for a family of four
Grandfathered Plan – a health plan that was in existence on the March 23, 2010 ACA effective date

10. Glossary of Terms
Guaranteed Issue – beginning in 2014, the ACA requires issuers to offer coverage to all non- Grandfathered plans, without regard to the following:
Pre-existing conditions
Health status
Medical conditions
Claims experience
Receipt of health care
Medical history

11. Glossary of Terms
High-Risk Pool (Pre-existing Condition Insurance Plan [PCIP]) – the ACA expands upon the current state-based high-risk pool system. The ACA requires the government to establish or issue contracts to establish a temporary PCIP (through 2013) to provide coverage for eligible individuals with pre-existing conditions by appropriating $5 billion to subsidize premiums. Eligibility is limited to individuals who have been uninsured for at least six months and have certain pre-existing conditions

12. Glossary of Terms
Individual Mandate – the ACA requires that most individuals obtain minimum essential coverage or pay a penalty beginning in Exemptions to this requirement include, but are not limited to, religious objections, individuals with incomes less than 100% of FPL, Indian tribe members, and hardship waivers
Lifetime Limits – the ACA prohibits a health plan from establishing lifetime limits on “essential health benefits” (except for grandfathered individual plans)

13. Glossary of Terms
Medical Loss Ratio (MLR) – the minimum percentage of premium dollars a health plan must spend on the reimbursement of certain medical costs
Medicare Part D Donut Hole – a gap in prescription drug coverage under Medicare Part D, where beneficiaries pay 100% of their prescription drug costs after their total drug costs exceed an initial coverage limit and until they qualify for a second tier of coverage

14. Glossary of Terms
Pre-existing Condition – an illness or medical condition that existed prior to your applying for a health plan, whether or not any medical advice or treatment was recommended or received. The ACA prohibits health plans from imposing any pre-existing condition exclusions for plan and policy years beginning after 9/23/10 for children under 19, and for all others beginning in 2014

15. Glossary of Terms
Premium Subsidies – a fixed amount of money, or a designated percentage of the premium cost, that is provided to help people purchase health insurance. The ACA provides premium subsidies to individuals with incomes between 133% and 400% of the FPL level that purchase health plans through the Exchanges beginning in These are also known as premium tax credits under the ACA

16. Glossary of Terms
Preventive Care Services – health care that emphasizes the early detection, prevention, and treatment of disease
Qualified Health Plan – health plans that are offered through an Exchange, which have been certified as providing the essential health benefits package as required by the ACA

17. Glossary of Terms
Reinsurance – the ACA includes a provision to establish a temporary reinsurance program for years for issuers that cover high-risk individuals
Rescission – rescission is a retroactive cancellation or discontinuance of your coverage due to fraud or intentional misrepresentation of material fact

18. Glossary of Terms
Risk Adjustment – the process of increasing or reducing payments to health plans to reflect higher or lower than expected spending. Risk adjusting is designed to compensate health plans that enroll a sicker population as a way to discourage plans from selecting only healthier individuals
Risk Corridor – a temporary provision in ACA for years that requires plans whose costs are lower than anticipated to make payments into a fund that reimburses plans whose costs are higher than expected

19. Glossary of Terms
Small Business Tax Credit – the ACA provides certain small businesses that offer health plans a tax credit. These tax credits vary with size, contribution, and tax status of the small business
Small Group – the Alabama Department of Insurance regulates small employer health plans with 2-50 employees. Alabama will expand this definition to employees as required by ACA

20. Glossary of Terms
Tax Deduction – the ACA will raise the amount of itemized expenses that a person can deduct from adjusted gross income from the current 7.5% to 10% in 2013 (this increase is waived for individuals 65 and older for tax years )

21. Provisions and Timeline

22. 2010 New consumer protections Improving quality and lowering costs
Increasing access to affordable care
In 2010, a new Patient’s Bill of Rights went into effect, protecting consumers from the worst abuses of the insurance industry. Cost-free preventive services begin for many Americans

23. New Consumer Protections
Putting information for consumers online (7/1/10)
Prohibiting denying coverage of children based on pre- existing conditions (9/23/10)
Prohibiting insurance companies from rescinding coverage (9/23/10)
Eliminating lifetime limits on insurance coverage (9/23/10)
Regulating annual limits on insurance coverage (9/23/10)
Appealing insurance company decisions by consumers (9/23/10)
Establishing consumer assistance programs in the states (10/10)

24. Improving Quality and Lowering Costs
Providing small business health insurance tax credits
Offering relief for 4 million seniors who hit the Medicare prescription drug donut hole (6/10)
Providing free preventive care (9/23/10)
Preventing disease and illness (2010)
Cracking down on health care fraud

25. Increasing Access to Affordable Care
Providing access to insurance for uninsured Americans with pre-existing conditions (7/1/10)
Extending coverage for young adults (9/23/10)
Expanding coverage for early retirees (6/1/10)
Rebuilding the primary care workforce (2010)
Holding insurance companies accountable for unreasonable rate hikes (2010)
Allowing states to cover more people on Medicaid (4/1/10)
Increasing payments for rural health care providers (2010)
Strengthening community health centers (2010)

26. 2011 Improving quality and lowering costs
Increasing access to affordable care
Holding insurance companies accountable
In 2011, people with Medicare can get key preventive services for free, and also receive a 50% discount on brand-name drugs in the Medicare donut hold

27. Improving Quality and Lowering Costs
Offering prescription drug discounts (1/1/11)
Providing free preventive care for seniors (1/1/11)
Improving health care quality and efficiency (1/1/11)
Improving care for seniors after they leave the hospital (1/1/11)
Introducing new innovations to bring down costs (10/1/11)

28. Increasing Access to Affordable Care
Increasing access to services at home and in the community (10/1/11)

29. Holding Insurance Companies Accountable
Bringing down health care premiums (1/1/11)
Addressing overpayments to big insurance companies and strengthening Medicare Advantage (1/1/11)

30. 2012 Improving quality and lowering costs
Increasing access to affordable care
In 2012, Accountable Care Organizations and other programs help doctors and health care providers work together to deliver better care

31. Improving Quality and Lowering Costs
Linking payment to quality outcomes (10/1/12)
Encouraging integrated health systems (1/1/12)
Reducing paperwork and administrative costs (10/1/12)
Understanding and fighting health disparities (3/12)

32. Increasing Access to Affordable Care
Providing new, voluntary options for long-term care insurance (not effective at this time)

33. 2013 Improving quality and lowering costs
Increasing access to affordable care
In 2013, open enrollment in the Health Insurance Marketplace begins on October 1st

34. Improving Quality and Lowering Costs
Improving preventive health coverage (1/1/13)
Expanding authority to bundle payments (1/1/13)

35. Increasing Access to Affordable Care
Increasing Medicaid payments for Primary Care doctors (1/1/13)
Open enrollment in the Health Insurance Marketplace begins (10/1/13)

36. 2014 New consumer protections Improving quality and lowering costs
Increasing access to affordable care
In 2014, all Americans will have access to affordable health insurance options. The Marketplace will allow individuals and small businesses to compare health plans on a level playing field. Middle and low-income families will get tax credits that cover a significant portion of the cost of coverage. The Medicaid program will be expanded to cover more low-income Americans.

37. New Consumer Protections
Prohibiting discrimination due to pre-existing conditions or gender (1/1/14)
Eliminating annual limits on insurance coverage (1/1/14)
Ensuring coverage of individuals participating in clinical trials (1/1/14)

38. Improving Quality and Lowering Costs
Making care more affordable (1/1/14)
Establishing the Health Insurance Marketplace (2014)
Increasing the small business tax credit (1/1/14)

39. Increasing Access to Affordable Care
Increasing access to Medicaid (1/1/14)
Promoting individual responsibility (1/1/14)

40. 2015
Improving quality and lowering costs

41. Improving Quality and Lowering Costs
Paying physician based on value not volume (1/1/15)

42. References
Health Care Glossary for Affordable Care Act (ACA). Aldoi.gov. Retrieved from areGlossary.pdf
Key Features of the Affordable Care Act by Year. HHS.gov/HealthCare. Retrieved from meline-text.html