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In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a significant portion of their funding.
The Health Insurance Portability and Accountability Act of 1996 is a United States Act of Congress enacted by the 104th United States Congress and signed into law by President Bill Clinton on August 21, 1996. It aimed to alter the transfer of healthcare information, stipulated the guidelines by which personally identifiable information maintained by the healthcare and healthcare insurance industries should be protected from fraud and theft, and addressed some limitations on healthcare insurance coverage. It generally prohibits healthcare providers and businesses called covered entities from disclosing protected information to anyone other than a patient and the patient's authorized representatives without their consent. The bill does not restrict patients from receiving information about themselves. Furthermore, it does not prohibit patients from voluntarily sharing their health information however they choose, nor does it require confidentiality where a patient discloses medical information to family members, friends or other individuals not employees of a covered entity.
Medicare Advantage is a capitated program for providing Medicare benefits in the United States. Under Part C, Medicare pays a sponsor a fixed payment. The sponsor then pays for the health care expenses of enrollees. Sponsors are allowed to vary the benefits from those provided by Medicare's Parts A and B as long as they provide the actuarial equivalent of those programs. The sponsors vary from primarily integrated health delivery systems to unions to other types of non profit charities to insurance companies. The largest sponsor is a hybrid: the non profit charity AARP using UnitedHealth.
In the United States, health insurance marketplaces, also called health exchanges, are organizations in each state through which people can purchase health insurance. People can purchase health insurance that complies with the Patient Protection and Affordable Care Act at ACA health exchanges, where they can choose from a range of government-regulated and standardized health care plans offered by the insurers participating in the exchange.
Members of the United States population between the ages of 18 and 29 who decide that it is in their financial best interest to forgo health insurance are sometimes referred to as young invincibles by the insurance industry, a term coined to express the idea that the young demographic perceives themselves as immune to sickness and injury. The argument is that these individuals are young and in good health, so they have a low risk of experiencing substantial health issues that would lead to large amounts of spending on health care. Further, this group tends to have a mentality of “it won’t happen to me” with regards to most causes of injury. Together, these beliefs lead to the young invincibles not purchasing insurance.
The Pre-existing Condition Insurance Plan (PCIP) was a form of health insurance coverage offered to uninsured Americans who were unable to obtain coverage because of a pre-existing condition. These provided coverage to as many as 350,000 people to fill the gap until the Affordable Care Act went into effect in 2014. The plan was funded by congress through the Department of Health and Human Services to monitor and distribute. States had programs either operated individually run or administered by HHS with 23 states and the District of Columbia. The plans were open through an Association or Government Employees Health Association (GEHA). The program has since ceased in order to make certain funding would be sufficient to carry the existing approximately 100,000 members it has taken on since PCIP inception.
Covered California is the health insurance marketplace in the U.S. state of California established under the federal Patient Protection and Affordable Care Act (ACA). The exchange enables eligible individuals and small businesses to purchase private health insurance coverage at federally subsidized rates. It is administered by an independent agency of the government of California.
Health care finance in the United States discusses how Americans obtain and pay for their healthcare, and why U.S. healthcare costs are the highest in the world based on various measures.
Washington Healthplanfinder is one of the fourteen health insurance marketplaces in the United States and was created in accordance with the Patient Protection and Affordable Care Act, commonly referred to as Obamacare.
The Affordable Care Act (ACA) is divided into 10 titles and contains provisions that became effective immediately, 90 days after enactment, and six months after enactment, as well as provisions phased in through to 2020. Below are some of the key provisions of the ACA. For simplicity, the amendments in the Health Care and Education Reconciliation Act of 2010 are integrated into this timeline.
HealthCare.gov is a health insurance exchange website operated by the United States federal government under the provisions of the Affordable Care Act or ACA, commonly referred to as "Obamacare", which currently serves the residents of the U.S. states which have opted not to create their own state exchanges. The exchange facilitates the sale of private health insurance plans to residents of the United States and offers subsidies to those who earn between one and four times the federal poverty line, but not to those earning less than the federal poverty line. The website also assists those persons who are eligible to sign up for Medicaid, and has a separate marketplace for small businesses.
Arkansas Health Connector/Arkansas Private option is the health insurance marketplace, previously known as health insurance exchange, in the U.S. state of Arkansas, created in accordance with the Patient Protection and Affordable Care Act. The marketplace operates a web site and a toll-free resource center.
kynect, formerly and also called the Kentucky Health Benefit Exchange, is the health insurance marketplace, previously known as health insurance exchange, in the U.S. Commonwealth of Kentucky, created by then-Governor Steve Beshear in accordance with the Patient Protection and Affordable Care Act. Steve Beshear's successor as governor, Matt Bevin, ended Kynect enrollment for individuals as of 2017. From 2017 to 2020, the marketplace operated a web site for small business owners. Bevin's successor, Andy Beshear, announced on June 17, 2020, that Kentucky will reestablish a state health insurance marketplace similar to kynect, with full implementation by January 1, 2022. Kynect was officially relaunched on October 5, 2020, with full implementation in January 2022.
New Mexico Health Insurance Exchange, otherwise known as BeWellNM, is the health insurance marketplace for the U.S. state of New Mexico. The exchange enables people and small businesses to purchase health insurance at federally subsidized rates.
Patient navigators educate and assist United States citizens in enrolling into health benefit plans stipulated in the Patient Protection and Affordable Care Act (ACA). Patient navigators are also called "insurance navigators" or "in-person assisters" who have defined roles under the ACA. Although their roles might overlap, patient navigators are not community health workers or health advocates. "Navigators" work in states with Federally-Facilitated Exchanges (FFEs) or State Partnership Exchanges.
The federal Small Business Health Options Program is an insurance exchange, created by Patient Protection and Affordable Care Act (Obamacare). The Small Business Health Options Program (SHOP) Marketplace helps small businesses to provide health coverage to their employees. Therefore, it is open to employers with 50 or fewer full-time equivalent employees (FTEs), in which it also includes non-profit organizations.
In the context of American public healthcare policy, the Medicaid coverage gap refers to uninsured people who do not qualify for marketplace assistance under the Affordable Care Act (ACA) and reside in states that have not adopted Medicaid expansion under the ACA. People within this categorization have incomes above the eligibility limits for Medicaid set by their state of residence but fall below the federal poverty line (FPL), resulting in deficient access to affordable health insurance. As of March 2023, an estimated 1.9 million Americans in 10 states are within the Medicaid coverage gap according to the Kaiser Family Foundation. Approximately 97 percent of this cohort lives in the Southern U.S., with a majority living in Texas and Florida; Texas has the largest population of people in the cohort, accounting for 41 percent of people in the coverage gap.
The Patient Protection and Affordable Care Act, often shortened to the Affordable Care Act (ACA) or nicknamed Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the passage of Medicare and Medicaid in 1965. Once the law was signed, provisions began taking effect, in a process that continued for years. Some provisions never took effect, while others were deferred for various periods.
Enhanced Direct Enrollment (EDE) is a provision in the United States that allows certain private entities, including insurance carriers and web-brokers, to directly enroll consumers in Qualified Health Plans through the Health Insurance Marketplace without redirecting consumers to Healthcare.gov. Approved EDE partners may access a suite of APIs which allow them to directly submit and update applications on the federal exchange.
GoHealth is an American marketplace for Medicare plans including Medicare Advantage, MediGap and Medicare Part D, which are programs administered through private health insurance companies. It also operates an online health insurance marketplace offering individual health insurance and short-term health insurance.
References
- 1 2 "Federal Marketplace Progress Fact Sheet - Centers for Medicare & Medicaid Services". Cms.gov. 2012-05-16. Retrieved 2013-07-02.
- ↑ §1321(c) of ACA
- ↑ "Fact sheet" (PDF). www.cms.gov. 2013. Retrieved 2019-07-03.
- ↑ "State-based Exchanges | CMS".