The Patient Protection and Affordable Care Act

Accessibility

• Establishment of a Marketplace that helps individuals and small groups purchase insurance.
• Medicaid expansion under the ACA provides Medicaid coverage to almost all adults with incomes lower than 138% of the Federal Poverty Level. This expansion has been enacted in 41 states. Check whether your state participated in Medicaid Expansion in Kaiser Family Foundation’s Interactive Map. If your state is not covered, you can schedule an office hours call with Caribou to learn more about your options.
• Premium Tax Credits and Cost-Sharing Reductions, both of which are based on income and a number of other factors, help to reduce the cost of monthly plan premiums.

Quality of Care

• The ACA introduced the Shared Savings Program.. The program encouraged providers, facilities, and stakeholders to form Accountable Care Organizations (ACOs). You may think of an ACO as a network of providers coming together to coordinate your care. This was implemented in hopes of moving away from charging for every provided service (fee-for-service) towards focusing on healthy outcomes (value-based care).
• Many value-based payment initiatives were implemented to reduce hospital readmissions. One of the earliest programs, called the Hospital Readmission Reduction Program, penalized hospitals with high rates of unplanned readmissions within 30 days of discharge. This penalty was applicable to discharges relating to six different conditions.
• Bundled payment models were introduced to incentivize more coordination between care teams and less unnecessary testing and procedures.

Patient Protections

• Pre-existing conditions may not be used by insurance companies to deny you coverage or increase plan costs.
• Adult children may stay on a parent’s plan until they turn 26 years old.
• Insurance companies may not impose yearly or lifetime limits on the dollar amount they will cover.
• FDA-approved contraceptive methods must be covered without copay when prescribed by an in-network provider.
• The ACA mandated that plans offered in the Marketplace must cover 10 essential health benefits.