Welcome! The Topic For Today Is…

1. Welcome! The Topic For Today Is…

2. Health Care Reform!

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 Back

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 Back

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 Back

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. Back

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 Back

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 Back

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. Back

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. Back

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 Back

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 Back

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. Back

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 Back

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 Back

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 Back

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  Back

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. Back

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 Back

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. Back

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. Back

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. Back

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) Back

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 Back

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 Back

26. Daily Double The Winner Of The Last Round Write Down How Much Money You Are Willing To Risk If You get the Question rightyou 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 Back

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 Back

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 Back