Chapter Recap
This chapter provided an overview of the Patient Protection and Affordable Care Act (PPACA), its coverage options and required benefits. Let's recap them:
| AFFORDABLE CARE ACT (ACA) |
| Features and Coverages |
- Mandates preventive, educational, and community based health care
- Premium rates may be based on geographic rating area, family composition, age, and tobacco use
- Children are covered until age 26
- Coverage for pre-existing conditions
- Enrollment period: November 1 to January 31
- Metal levels/plan covers:
- Bonze 60%
- Silver 70%
- Gold 80%
- Platinum 90%
- Grandfathered plan - existing provisions that are not required to change in response to new laws, restrictions or requirements
|
| Eligibility |
- Must be a U.S. citizen or national or be lawfully present in the United States
- Must live in the United States
- Cannot be currently incarcerated
|
| Essential Health Benefits |
10 essential benefits:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Pregnancy, maternity and newborn care
- Mental health and substance use
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
|
| Insurance Exchanges (Marketplace) |
- Federally-facilitated marketplace
- State exchanges
- SHOP
- Helps applicants to:
- Compare private health plans
- Obtain information about health coverage options and eligibility or tax credits
- Enroll in an appropriate health plan
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