Essential Health Benefits Balancing Coverage and Cost (2012) / Chapter Skim
Currently Skimming:
Appendix B: Stakeholder Decisions on Health Insurance
Appendix B: Stakeholder Decisions on Health Insurance
Pages 159-168
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 159... ...
Beginning after 2016, the penalty will be increased annually by the cost-of-living adjustment. Exemptions will be granted for financial hardship and religious objections, to American Indians, those without coverage for less than 3 months, undocumented immigrants, incarcerated individuals, those for whom the lowest-cost plan option exceeds 8.0 percent of an individual's income, and those with incomes below the tax filing threshold (in 2009 the threshold for taxpayers under age 65 was $9,350 for singles and $18,700 for couples)
|
From page 160... ...
critical that the imposed penalty amount is too low to motivate many to buy insurance, particularly if the premiums associated with the essential health benefits (EHB) are high (Laszewski, 2010)
|
From page 161... ...
The cost for indi viduals to purchase insurance in the exchange is likely to result in a premium that is 10-13 percent higher than without ACA requirements, given the more comprehensive nature of the required essential health benefits and the constraints on OOP. On the other hand, premiums would be effectively reduced by 56-59 percent for individuals who qualify for premium subsidies (CBO, 2009)
|
From page 162... ...
Key dollar considerations for employers and employees are outlined in Box B-2. Level of Tax Credit In making decisions to offer health insurance and/or to self-insure, employers will have to take into account tax credits, the applicable fees or penalties for not participating, and the availability of tax credits for employees, currently and into the future.
|
From page 163... ...
. Costs CBO analyses suggest that small firms with fewer than 50 employees could experience a range of premium change by 2016 from a 2 percent decrease to a 1 percent increase without the small business tax credit; however, the tax credit would reduce premiums 8-11 percent for eligible firms (CBO, 2009)
|
From page 164... ...
This is especially important because individuals and families frequently face eligibility changes -- "churning" in and out of Medicaid eligibility and enrollment (Sommers and Rosenbaum, 2011; Washington State Health Benefit Exchange Project Health Care Authority, 2010)
|
From page 165... ...
Products Insurers participating in the exchanges must offer at least one gold and one silver plan, 12 each of which must meet certain standards regarding benefits,13 providers (including essential community providers) ,14 cost-sharing,15 10 These exempt individuals include mandatory categories of pregnant women; blind or disabled individuals; dual eligibles; terminally ill hospice patients; those eligible on basis of institutionalization; medically frail and special needs individuals; beneficiaries qualifying for long term care services; children in foster care receiving child welfare services and children receiving foster care or adoption assistance; TANF (Temporary Assistance for Needy Families)
|
From page 166... ...
PowerPoint Presentation to the IOM Committee on the Determination of Essential Health Benefits by Jessica Banthin, Economist, Center for Financing, Access and Cost Trends, Agency for Healthare Research and Quality, Costa Mesa, CA, March 2. Banthin, J
|
From page 167... ...
:228-236. Washington State Health Benefit Exchange Project Health Care Authority.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.