Key Features of the Affordable Care Act By Year

Source: HHS

On March 23, 2010, President Obama signed the Affordable Care Act. The law p ts in place comprehensi!e health ins rance reforms that will roll o t o!er fo r "ears and be"ond. #se the lin$s below to learn abo t what%s changing and when& OVERVIEW OF THE HEA TH CARE AW !"#": A new Patient's (ill of )ights goes into effect, protecting cons mers from the worst ab ses of the ins rance ind str". Cost* free pre!enti!e ser!ices begin for man" Americans. See $ore !"#" Cha%&es. !"##: People with Medicare can get $e" pre!enti!e ser!ices for free, and also recei!e a +0, disco nt on brand*name dr gs in the Medicare -don t hole.. See $ore !"## Cha%&es. !"#!: Acco ntable Care Organi/ations and other programs help doctors and health care pro!iders wor$ together to deli!er better care. See $ore !"#! Cha%&es. !"#': Open enrollment in the 0ealth 1ns rance Mar$etplace begins on October 1st. See $ore !"#' Cha%&es. !"#(: All Americans will ha!e access to affordable health ins rance options. The Mar$etplace allows indi!id als and small b sinesses to compare health plans on a le!el pla"ing field. Middle and low*income families will get ta2 credits that co!er a significant portion of the cost of co!erage. And the Medicaid program will be e2panded to co!er more low*income Americans. All together, these reforms mean that millions of people who were

pre!io sl" nins red will gain co!erage, than$s to the Affordable Care Act. See $ore !"#( Cha%&es.

2010
)EW CO)S*$ER +ROTECTIO)S +utt,%& I%for-at,o% for Co%su-ers O%l,%e. The law pro!ides for where cons mers can compare health ins rance co!erage options and pic$ the co!erage that wor$s for them. Effect,/e 0uly #1 !"#". +roh,b,t,%& 2e%y,%& Co/era&e of Ch,ldre% Based o% +re3E4,st,%& Co%d,t,o%s. The health care law incl des new r les to pre!ent ins rance companies from den"ing co!erage to children nder the age of 13 d e to a pre*e2isting condition. Effect,/e for health 5la% years be&,%%,%& o% or after Se5te-ber !'1 !"#" for %e6 5la%s a%d e4,st,%& &rou5 5la%s. +roh,b,t,%& I%sura%ce Co-5a%,es fro- Resc,%d,%& Co/era&e. 1n the past, ins rance companies co ld search for an error, or other technical mista$e, on a c stomer%s application and se this error to den" pa"ment for ser!ices when he or she got sic$. The health care law ma$es this illegal. After media reports cited incidents of breast cancer patients losing co!erage, ins rance companies agreed to end this practice immediatel". Effect,/e for health 5la% years be&,%%,%& o% or after Se5te-ber !'1 !"#". El,-,%at,%& ,fet,-e ,-,ts o% I%sura%ce Co/era&e. #nder the law, ins rance companies will be prohibited from imposing lifetime dollar limits on essential benefits, li$e hospital sta"s. Effect,/e for health 5la% years be&,%%,%& o% or after Se5te-ber !'1 !"#". Re&ulat,%& A%%ual ,-,ts o% I%sura%ce Co/era&e. #nder the law, ins rance companies% se of ann al dollar limits on the amo nt of ins rance co!erage a patient ma" recei!e will be restricted for new plans in the indi!id al mar$et and all gro p plans. 1n 2014, the se of ann al dollar limits on essential benefits li$e hospital sta"s will be banned for new plans in the indi!id al mar$et and all gro p plans. Effect,/e for health 5la% years be&,%%,%& o% or after Se5te-ber !'1 !"#". A55eal,%& I%sura%ce Co-5a%y 2ec,s,o%s. The law pro!ides cons mers with a wa" to appeal co!erage determinations or claims to their

ins rance compan", and establishes an e2ternal re!iew process. Effect,/e for %e6 5la%s be&,%%,%& o% or after Se5te-ber !'1 !"#". Establ,sh,%& Co%su-er Ass,sta%ce +ro&ra-s ,% the States. #nder the law, states that appl" recei!e federal grants to help set p or e2pand independent offices to help cons mers na!igate the pri!ate health ins rance s"stem. These programs help cons mers file complaints and appeals5 enroll in health co!erage5 and get ed cated abo t their rights and responsibilities in gro p health plans or indi!id al health ins rance policies. The programs will also collect data on the t"pes of problems cons mers ha!e, and file reports with the #.6. 7epartment of 0ealth and 0 man 6er!ices to identif" tro ble spots that need f rther o!ersight. 7ra%ts A6arded October !"#". I$+ROVI)7 8*A ITY A)2 OWERI)7 COSTS +ro/,d,%& S-all Bus,%ess Health I%sura%ce Ta4 Cred,ts. #p to 4 million small b sinesses are eligible for ta2 credits to help them pro!ide ins rance benefits to their wor$ers. The first phase of this pro!ision pro!ides a credit worth p to 3+, of the emplo"er%s contrib tion to the emplo"ees% health ins rance. 6mall non*profit organi/ations ma" recei!e p to a 2+, credit. Effect,/e %o6. Offer,%& Rel,ef for ( $,ll,o% Se%,ors Who H,t the $ed,care +rescr,5t,o% 2ru& 92o%ut Hole.: An estimated fo r million seniors will reach the gap in Medicare prescription dr g co!erage $nown as the -don t hole. this "ear. 8ach eligible senior will recei!e a one*time, ta2 free 92+0 rebate chec$. F,rst chec;s -a,led ,% 0u%e1 !"#"1 a%d 6,ll co%t,%ue -o%thly throu&hout !"#" as se%,ors h,t the co/era&e &a5. :earn more abo t the ;don t hole; and Medicare. +ro/,d,%& Free +re/e%t,/e Care. All new plans m st co!er certain pre!enti!e ser!ices s ch as mammograms and colonoscopies witho t charging a ded ctible, co*pa" or coins rance. Effect,/e for health 5la% years be&,%%,%& o% or after Se5te-ber !'1 !"#". :earn more abo t pre!enti!e care benefits. 6ee the f ll list of co!ered pre!enti!e ser!ices. +re/e%t,%& 2,sease a%d Ill%ess. A new 91+ billion Pre!ention and P blic 0ealth < nd will in!est in pro!en pre!ention and p blic health programs that can help $eep Americans health" = from smo$ing cessation to combating obesit". Fu%d,%& be&,%s ,% !"#". 6ee pre!ention f nding and grants in "o r state. Crac;,%& 2o6% o% Health Care Fraud. C rrent efforts to fight fra d ha!e ret rned more than 92.+ billion to the Medicare Tr st < nd in

fiscal "ear 2003 alone. The new law in!ests new reso rces and re> ires new screening proced res for health care pro!iders to boost these efforts and red ce fra d and waste in Medicare, Medicaid, and C01P. $a%y 5ro/,s,o%s effect,/e %o6. I)CREASI)7 ACCESS TO AFFOR2AB E CARE +ro/,d,%& Access to I%sura%ce for *%,%sured A-er,ca%s 6,th +re3 E4,st,%& Co%d,t,o%s. The Pre*82isting Condition 1ns rance Plan pro!ides new co!erage options to indi!id als who ha!e been nins red for at least si2 months beca se of a pre*e2isting condition. 6tates ha!e the option of r nning this program in their state. 1f a state chooses not to do so, a plan will be established b" the 7epartment of 0ealth and 0 man 6er!ices in that state. )at,o%al 5ro&ra- effect,/e 0uly #1 !"#". E4te%d,%& Co/era&e for You%& Adults. #nder the law, "o ng ad lts will be allowed to sta" on their parents% plan ntil the" t rn 2? "ears old @in the case of e2isting gro p health plans, this right does not appl" if the "o ng ad lt is offered ins rance at wor$A. Chec$ with "o r ins rance compan" or emplo"er to see if "o > alif". Effect,/e for health 5la% years be&,%%,%& o% or after Se5te-ber !'. E45a%d,%& Co/era&e for Early Ret,rees. Too often, Americans who retire witho t emplo"er*sponsored ins rance and before the" are eligible for Medicare see their life sa!ings disappear beca se of high rates in the indi!id al mar$et. To preser!e emplo"er co!erage for earl" retirees ntil more affordable co!erage is a!ailable thro gh the new 82changes b" 2014, the new law creates a 9+ billion program to pro!ide needed financial help for emplo"ment*based plans to contin e to pro!ide !al able co!erage to people who retire between the ages of ++ and ?+, as well as their spo ses and dependents. A55l,cat,o%s for e-5loyers to 5art,c,5ate ,% the 5ro&ra- a/a,lable 0u%e #1 !"#". <or more information on the 8arl" )etiree )eins rance Program, !isit www.8))P.go!. Rebu,ld,%& the +r,-ary Care Wor;force. To strengthen the a!ailabilit" of primar" care, there are new incenti!es in the law to e2pand the n mber of primar" care doctors, n rses and ph"sician assistants. These incl de f nding for scholarships and loan repa"ments for primar" care doctors and n rses wor$ing in nderser!ed areas. 7octors and n rses recei!ing pa"ments made nder an" state loan repa"ment or loan forgi!eness program intended to increase the a!ailabilit" of health care ser!ices in nderser!ed or health

professional shortage areas will not ha!e to pa" ta2es on those pa"ments. Effect,/e !"#" . Hold,%& I%sura%ce Co-5a%,es Accou%table for *%reaso%able Rate H,;es. The law allows states that ha!e, or plan to implement, meas res that re> ire ins rance companies to B stif" their premi m increases will be eligible for 92+0 million in new grants. 1ns rance companies with e2cessi!e or nB stified premi m e2changes ma" not be able to participate in the new health ins rance 82changes in 2014. 7ra%ts a6arded be&,%%,%& ,% !"#". Allo6,%& States to Co/er $ore +eo5le o% $ed,ca,d. 6tates will be able to recei!e federal matching f nds for co!ering some additional low* income indi!id als and families nder Medicaid for whom federal f nds were not pre!io sl" a!ailable. This will ma$e it easier for states that choose to do so to co!er more of their residents. Effect,/e A5r,l #1 !"#". I%creas,%& +ay-e%ts for Rural Health Care +ro/,ders. Toda", ?C, of medicall" nderser!ed comm nities across the nation are in r ral areas. These comm nities often ha!e tro ble attracting and retaining medical professionals. The law pro!ides increased pa"ment to r ral health care pro!iders to help them contin e to ser!e their comm nities. Effect,/e !"#". Stre%&the%,%& Co--u%,ty Health Ce%ters. The law incl des new f nding to s pport the constr ction of and e2pand ser!ices at comm nit" health centers, allowing these centers to ser!e some 20 million new patients across the co ntr". Effect,/e !"#".

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2011
I$+ROVI)7 8*A ITY A)2 OWERI)7 COSTS Offer,%& +rescr,5t,o% 2ru& 2,scou%ts. 6eniors who reach the co!erage gap will recei!e a +0, disco nt when b "ing Medicare Part 7 co!ered brand*name prescription dr gs. O!er the ne2t ten "ears, seniors will recei!e additional sa!ings on brand*name and generic dr gs ntil the co!erage gap is closed in 2020. Effect,/e 0a%uary #1 !"##. 7ownload a broch re to learn more @P7< * 1 M(A +ro/,d,%& Free +re/e%t,/e Care for Se%,ors. The law pro!ides certain free pre!enti!e ser!ices, s ch as ann al wellness !isits and personali/ed pre!ention plans for seniors on Medicare. Effect,/e 0a%uary #1 !"##. :earn more abo t pre!enti!e ser!ices nder Medicare.

 I-5ro/,%& Health Care 8ual,ty a%d Eff,c,e%cy. The law establishes a new Center for Medicare D Medicaid 1nno!ation that will begin testing new wa"s of deli!ering care to patients. These methods are e2pected to impro!e the > alit" of care, and red ce the rate of growth in health care costs for Medicare, Medicaid, and the Children%s 0ealth 1ns rance Program @C01PA. Additionall", b" Ean ar" 1, 2011, 006 will s bmit a national strateg" for > alit" impro!ement in health care, incl ding b" these programs. Effect,/e %o later tha% 0a%uary #1 !"##. :earn more abo t the Center for Medicare D Medicaid 1nno!ation. I-5ro/,%& Care for Se%,ors After They ea/e the Hos5,tal. The Comm nit" Care Transitions Program will help high ris$ Medicare beneficiaries who are hospitali/ed a!oid nnecessar" readmissions b" coordinating care and connecting patients to ser!ices in their comm nities. Effect,/e 0a%uary #1 !"##. I%troduc,%& )e6 I%%o/at,o%s to Br,%& 2o6% Costs. The 1ndependent Pa"ment Ad!isor" (oard will begin operations to de!elop and s bmit proposals to Congress and the President aimed at e2tending the life of the Medicare Tr st < nd. The (oard is e2pected to foc s on wa"s to target waste in the s"stem, and recommend wa"s to red ce costs, impro!e health o tcomes for patients, and e2pand access to high* > alit" care. Ad-,%,strat,/e fu%d,%& beco-es a/a,lable October #1 !"##. :earn more abo t strengthening Medicare. I)CREASI)7 ACCESS TO AFFOR2AB E CARE I%creas,%& Access to Ser/,ces at Ho-e a%d ,% the Co--u%,ty. The Comm nit" <irst Choice Option allows states to offer home and comm nit" based ser!ices to disabled indi!id als thro gh Medicaid rather than instit tional care in n rsing homes. Effect,/e be&,%%,%& October #1 !"##. HO 2I)7 I)S*RA)CE CO$+A)IES ACCO*)TAB E Br,%&,%& 2o6% Health Care +re-,u-s. To ens re premi m dollars are spent primaril" on health care, the law generall" re> ires that at least C+, of all premi m dollars collected b" ins rance companies for large emplo"er plans are spent on health care ser!ices and health care > alit" impro!ement. <or plans sold to indi!id als and small emplo"ers, at least C0, of the premi m m st be spent on benefits and > alit" impro!ement. 1f ins rance companies do not meet these goals, beca se their administrati!e costs or profits are too high, the" m st pro!ide rebates to cons mers. Effect,/e 0a%uary #1 !"##.

 Address,%& O/er5ay-e%ts to B,& I%sura%ce Co-5a%,es a%d Stre%&the%,%& $ed,care Ad/a%ta&e. Toda", Medicare pa"s Medicare Ad!antage ins rance companies o!er 91,000 more per person on a!erage than is spent per person in Traditional Medicare. This res lts in increased premi ms for all Medicare beneficiaries, incl ding the FF, of beneficiaries who are not c rrentl" enrolled in a Medicare Ad!antage plan. The law le!els the pla"ing field b" grad all" eliminating this discrepanc". People enrolled in a Medicare Ad!antage plan will still recei!e all g aranteed Medicare benefits, and the law pro!ides bon s pa"ments to Medicare Ad!antage plans that pro!ide high > alit" care. Effect,/e 0a%uary #1 !"##. :earn more abo t Medicare and the Affordable Care Act.

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2012
I$+ROVI)7 8*A ITY A)2 OWERI)7 COSTS ,%;,%& +ay-e%t to 8ual,ty Outco-es. The law establishes a hospital Gal e*(ased P rchasing program @G(PA in Traditional Medicare. This program offers financial incenti!es to hospitals to impro!e the > alit" of care. 0ospital performance is re> ired to be p blicl" reported, beginning with meas res relating to heart attac$s, heart fail re, pne monia, s rgical care, health*care associated infections, and patients% perception of care. Effect,/e for 5ay-e%ts for d,schar&es occurr,%& o% or after October #1 !"#!. E%coura&,%& I%te&rated Health Syste-s. The new law pro!ides incenti!es for ph"sicians to Boin together to form -Acco ntable Care Organi/ations.. These gro ps allow doctors to better coordinate patient care and impro!e the > alit", help pre!ent disease and illness and red ce nnecessar" hospital admissions. 1f Acco ntable Care Organi/ations pro!ide high > alit" care and red ce costs to the health care s"stem, the" can $eep some of the mone" that the" ha!e helped sa!e. Effect,/e 0a%uary #1 !"#!. Reduc,%& +a5er6or; a%d Ad-,%,strat,/e Costs. 0ealth care remains one of the few ind stries that relies on paper records. The new law will instit te a series of changes to standardi/e billing and re> ires health plans to begin adopting and implementing r les for the sec re, confidential, electronic e2change of health information. #sing electronic health records will red ce paperwor$ and administrati!e b rdens, c t costs, red ce medical errors and most importantl", impro!e the > alit" of care. F,rst re&ulat,o% effect,/e October #1 !"#!.

 *%dersta%d,%& a%d F,&ht,%& Health 2,s5ar,t,es. To help nderstand and red ce persistent health disparities, the law re> ires an" ongoing or new federal health program to collect and report racial, ethnic and lang age data. The 6ecretar" of 0ealth and 0 man 6er!ices will se this data to help identif" and red ce disparities. Effect,/e $arch !"#!. I)CREASI)7 ACCESS TO AFFOR2AB E CARE +ro/,d,%& )e61 Volu%tary O5t,o%s for o%&3Ter- Care I%sura%ce. The law creates a !ol ntar" long*term care ins rance program = called C:A66 ** to pro!ide cash benefits to ad lts who become disabled. )ote: O% October #(1 !"##1 Secretary Sebel,us tra%s-,tted a re5ort a%d letter to Co%&ress stat,%& that the 2e5art-e%t does %ot see a /,able 5ath for6ard for C ASS ,-5le-e%tat,o% at th,s t,-e. V,e6 a co5y of the C:A66 report.

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2013
I$+ROVI)7 8*A ITY A)2 OWERI)7 COSTS I-5ro/,%& +re/e%t,/e Health Co/era&e. To e2pand the n mber of Americans recei!ing pre!enti!e care, the law pro!ides new f nding to state Medicaid programs that choose to co!er pre!enti!e ser!ices for patients at little or no cost. Effect,/e 0a%uary #1 !"#'. :earn more abo t the law and pre!enti!e care. E45a%d,%& Author,ty to Bu%dle +ay-e%ts. The law establishes a national pilot program to enco rage hospitals, doctors, and other pro!iders to wor$ together to impro!e the coordination and > alit" of patient care. #nder pa"ment -b ndling,. hospitals, doctors, and pro!iders are paid a flat rate for an episode of care rather than the c rrent fragmented s"stem where each ser!ice or test or b ndles of items or ser!ices are billed separatel" to Medicare. <or e2ample, instead of a s rgical proced re generating m ltiple claims from m ltiple pro!iders, the entire team is compensated with a -b ndled. pa"ment that pro!ides incenti!es to deli!er health care ser!ices more efficientl" while maintaining or impro!ing > alit" of care. 1t aligns the incenti!es of those deli!ering care, and sa!ings are shared between pro!iders and the Medicare program. Effect,/e %o later tha% 0a%uary #1 !"#'. I)CREASI)7 ACCESS TO AFFOR2AB E CARE

 I%creas,%& $ed,ca,d +ay-e%ts for +r,-ary Care 2octors. As Medicaid programs and pro!iders prepare to co!er more patients in 2014, the Act re> ires states to pa" primar" care ph"sicians no less than 100, of Medicare pa"ment rates in 2013 and 2014 for primar" care ser!ices. The increase is f ll" f nded b" the federal go!ernment. Effect,/e 0a%uary #1 !"#'. :earn how the law s pports and strengthens primar" care pro!iders. O5e% E%roll-e%t ,% the Health I%sura%ce $ar;et5lace Be&,%s. 1ndi!id als and small b sinesses can b " affordable and > alified health benefit plans in this new transparent and competiti!e ins rance mar$etplace. Effect,/e October #1 !"#'.

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2014
)EW CO)S*$ER +ROTECTIO)S +roh,b,t,%& 2,scr,-,%at,o% 2ue to +re3E4,st,%& Co%d,t,o%s or 7e%der. The law implements strong reforms that prohibit ins rance companies from ref sing to sell co!erage or renew policies beca se of an indi!id al%s pre*e2isting conditions. Also, in the indi!id al and small gro p mar$et, the law eliminates the abilit" of ins rance companies to charge higher rates d e to gender or health stat s. Effect,/e 0a%uary #1 !"#(. :earn more abo t protecting Americans with pre*e2isting conditions. El,-,%at,%& A%%ual ,-,ts o% I%sura%ce Co/era&e . The law prohibits new plans and e2isting gro p plans from imposing ann al dollar limits on the amo nt of co!erage an indi!id al ma" recei!e. Effect,/e 0a%uary #1 !"#(. :earn how the law will phase o t ann al limits b" 2014. E%sur,%& Co/era&e for I%d,/,duals +art,c,5at,%& ,% Cl,%,cal Tr,als. 1ns rers will be prohibited from dropping or limiting co!erage beca se an indi!id al chooses to participate in a clinical trial. Applies to all clinical trials that treat cancer or other life*threatening diseases. Effect,/e 0a%uary #1 !"#(. I$+ROVI)7 8*A ITY A)2 OWERI)7 COSTS $a;,%& Care $ore Affordable. Ta2 credits to ma$e it easier for the middle class to afford ins rance will become a!ailable for people with income between 100, and 400, of the po!ert" line who are not eligible for other affordable co!erage. @1n 2010, 400, of the po!ert"

line comes o t to abo t 943,000 for an indi!id al or 9CC,000 for a famil" of fo r.A The ta2 credit is ad!anceable, so it can lower "o r premi m pa"ments each month, rather than ma$ing "o wait for ta2 time. 1t%s also ref ndable, so e!en moderate*income families can recei!e the f ll benefit of the credit. These indi!id als ma" also > alif" for red ced cost*sharing @copa"ments, co*ins rance, and ded ctiblesA. Effect,/e 0a%uary #1 !"#(. Establ,sh,%& the Health I%sura%ce $ar;et5lace. 6tarting in 2014 if "o r emplo"er doesn%t offer ins rance, "o will be able to b " it directl" in the 0ealth 1ns rance Mar$etplace. 1ndi!id als and small b sinesses can b " affordable and > alified health benefit plans in this new transparent and competiti!e ins rance mar$etplace. The Mar$etplace will offer "o a choice of health plans that meet certain benefits and cost standards. 6tarting in 2014, Members of Congress will be getting their health care ins rance thro gh the Mar$etplace, and "o will be able b " "o r ins rance thro gh Mar$etplace too. :earn more abo t the 0ealth 1ns rance Mar$etplace. I%creas,%& the S-all Bus,%ess Ta4 Cred,t. The law implements the second phase of the small b siness ta2 credit for > alified small b sinesses and small non*profit organi/ations. 1n this phase, the credit is p to +0, of the emplo"er%s contrib tion to pro!ide health ins rance for emplo"ees. There is also p to a 3+, credit for small non*profit organi/ations. Effect,/e 0a%uary #1 !"#(. :earn more abo t the small b siness ta2 credit. I)CREASI)7 ACCESS TO AFFOR2AB E CARE I%creas,%& Access to $ed,ca,d. Americans who earn less than 133, of the po!ert" le!el @appro2imatel" 914,000 for an indi!id al and 923,000 for a famil" of fo rA will be eligible to enroll in Medicaid. 6tates will recei!e 100, federal f nding for the first three "ears to s pport this e2panded co!erage, phasing to 30, federal f nding in s bse> ent "ears. Effect,/e 0a%uary #1 !"#(. +ro-ot,%& I%d,/,dual Res5o%s,b,l,ty. #nder the law, most indi!id als who can afford it will be re> ired to obtain basic health ins rance co!erage or pa" a fee to help offset the costs of caring for nins red Americans. 1f affordable co!erage is not a!ailable to an indi!id al, he or she will be eligible for an e2emption. Effect,/e 0a%uary #1 !"#(.

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201+
I$+ROVI)7 8*A ITY A)2 OWERI)7 COSTS

 +ay,%& +hys,c,a%s Based o% Value )ot Volu-e. A new pro!ision will tie ph"sician pa"ments to the > alit" of care the" pro!ide. Ph"sicians will see their pa"ments modified so that those who pro!ide higher !al e care will recei!e higher pa"ments than those who pro!ide lower > alit" care. Effect,/e 0a%uary #1 !"#<.

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HHS 6,ll %ot e%force these rules a&a,%st ,ssuers of sta%d3alo%e ret,ree3o%ly 5la%s ,% the 5r,/ate health ,%sura%ce -ar;et.