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Welcome! The Topic For Today Is…. Health Care Reform! Topic 1 The LAW Itself Topic 2 Populations Impacted Topic 3 Women Topic 4 Definitions Topic 5 Random.

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Presentation on theme: "Welcome! The Topic For Today Is…. Health Care Reform! Topic 1 The LAW Itself Topic 2 Populations Impacted Topic 3 Women Topic 4 Definitions Topic 5 Random."— Presentation transcript:

1 Welcome! The Topic For Today Is…

2 Health Care Reform! Topic 1 The LAW Itself Topic 2 Populations Impacted Topic 3 Women Topic 4 Definitions Topic 5 Random Things You Should Know By Now Bonus Question: 5000 pts

3 Topic 1: 200 Question: What are the exemptions for the individual mandate required by ACA? Answer 1) People are exempt for religious reasons; or 2) financial hardship

4 Topic 1: 400 Question: Will the health reform law allow a government panel to make decisions about end-of-life care for people on Medicare? Answer No such panels exist. While early versions of the law did contain provisions that would allow Medicare to reimburse physicians for voluntary discussions with patients about end-of-life, these provisions were dropped from the final legislation

5 Topic 1: 600 Question: What services are free because of the ACA under Medicare? Answer Includes full coverage for preventive health services and an annual exam

6 Topic 1: 800 Question How does the ACA help with limits for what insurers will pay for claims? Answer Health insurance reform eliminated lifetime limits (2010) and annual limits (2014) on how much insurance companies cover when an individual is sick.

7 Topic 1: 1000 Question: How does the ACA help with out-of-pocket spending? Answer Health insurance reform will limit what insurance companies can force an individual to pay in out-of-pocket expenses such as deductibles and copayments

8 Topic 2: 200 Question: Which group will Medicaid cover who rarely gets covered now? Answer Adults w/out Dependent Children under 138% of FPL

9 Topic 2: 400 Question: What major health insurance reform will help children get access to private health insurance? Answer As of Sept 2010, insurance plans can no longer discriminate against children under age 19 with pre-existing conditions, including babies born with health problems.

10 Topic 2: 600 Question: How does the ACA impact young adults? Answer The new law provides that as of Sept. 2010, adult children up to age 26 may remain on or go back on to their parent’s insurance coverage, if they do not already have access to health insurance through their employer.

11 Topic 2: 800 Question: Are undocumented immigrants eligible to purchase a qualified health plan (QHP) within the Exchange? Answer Unfortunately, the law does allow undocumented immigrants to purchase insurance for themselves within the exchanges, though they are able to purchase independent individual plans within the private market

12 Topic 2: 1000 Question: I’m hungry - So what’s all this chatter about a donut hole? Answer Eligible seniors who are in the coverage gap known as the “donut hole” automatically receive a discount on prescription drugs in 2011 and beyond

13 Topic 3: 200 Question: How does the ACA help women get access to private health insurance and afford it? Answer Women will not be able to denied insurance because of their pre-existing conditions. It also prohibits gender rating by insurers.

14 Topic 3: 400 Question: How does the ACA help women get access to services they need? (Two parts) Answer Part one: Already requires coverage of preventive services, many of which are specific to women Part two: Requires coverage of women’s services as of August 2012

15 Topic 3: 600 Question: What are some preventative services offered to women thanks to the ACA? Answer FDA-approved contraception methods, contraceptive counseling, well-woman visits, screening for gestational diabetes, breastfeeding, support, supplies, & counseling

16 Topic 3: 800 Question: What issue could effect women and other high needs users of health care when insurers participate in health exchanges? Answer Adverse selection

17 Topic 3: 1000 Question: Approximately how many women will gain coverage when ACA is fully implemented in 2014? Answer 17 million women will gain coverage thanks to the Affordable Care Act

18 Topic 4: 200 Question: What is a QHP? Answer A qualified health plan in Exchanges. They have to be certified, provide essential health benefits, follow established limits on cost- sharing and meets other requirements.

19 Topic 4: 400 Question: Who can be Navigators? Answer Community Based Organizations and Brokers. Navigators are a consumer-assistance role written into the original language of the ACA to ensure that people can reach the Exchange to purchase individual coverage

20 Topic 4: 600 Question: What is the rate increase generally not acceptable according to the ACA? (PERCENTAGE) Answer 10 PERCENT. The state or federal government will examine the health insurer's data on each rate increase and determine whether it is reasonable or not.

21 Topic 4: 800 Question: What is Medical Loss Ratio (MLR) and what are the ratios? Answer Refers to the amount of insurance premiums that an insurer spends on health care and activities that improve health care quality. 80% for the individual and small group markets, 85% in large group market.

22 Topic 4: 1000 Question: What four things can insurers still rate people for? Answer Age (limited to 3:1), geography, tobacco use, family size.

23 Topic 5: 200 Question: How will the ACA help people cover the costs of health insurance (above 138% of FPL)? Answer Tax credits for people who do not qualify for Medicare or Medicaid, and under 400% FPL (known as premium subsidies)

24 Topic 5: 400 Question: Do the ACA insurance requirements apply to self-insured health plans? Answer No they are regulated under ERISA, but there is still legal debate about this

25 Topic 5: 600 Question: Name three of the Essential Health Benefits that must be covered by insurance after 2014 Answer Ambulatory, emergency, hospitalization, maternity, mental health and substance abuse disorder treatment, prescription drugs, rehabilitative and habilitative services, laboratory services, preventive and wellness service and chronic disease management, pediatric services including oral and vision care

26 The Winner Of The Last Round Write Down How Much Money You Are Willing To Risk If You get the Question write you win that money If you get it wrong you Loss the money!

27 Topic 5: 800 DAILY DOUBLE!! Question: Who is allowed to purchase catastrophic plans to meet the individual mandate after 2014 other than people under 30? Answer People who qualify for the financial hardship exemption

28 Topic 5: 1000 Question: What was recently determined by HHS for the Medical Loss Ratio (MLR) and administrative services? Answer That brokers fees will be calculated into the MLR ratio

29 Bonus Question: 5000 pts. Question: What is required of restaurant chains with over 20 locations under the ACA? Answer List calorie content information for standard menu items, including drive-thrus and and menu boards


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