Healthcare Reform Acronyms

It's no wonder we are all confused. Here's are some acronyms that you may come across when reading about healthcare reform.

ACA	Affordable Care Act
ACO	Accountable Care Organization
ADA	Americans with Disabilities Act of 1990
AHO	Accountable Health Organization
APFC	Advanceable Premium Tax Credit
ARRA	American Recovery and Reinvestment Act of 2009 ("Stimulus Bill")
AV	Actuarial Values
BIIP	Basic Health Plan
CHlP	Children's Health Insurance Program, enacted 1977
CHlPRA	Children's Health Insurance Program Reauthorization Act of 2009
CMS	Centers for Medicare & Medicaid Services
CO-OP	Consumer Operated and Oriented Plan
DOL	Department of Labor
ECP	Essential Community Provider
EHB	Essential Health Benefits
EHR	Electronic Health Record
ESI	Employer Sponsored Insurance
FEHBP	Federal Employees Health Benefits Program
FFS	Fee-For-Service
FLSA	Fair Labor Standards Act
FMAP	Federal Medical Assistance Percentage
FPL	Federal Poverty Level
FQHC	Federally Qualified Health Center
FR	Federal Register
FT   or  (FTE)	Full Time   (Full Time Equivalent)
GF	Grandfathered Health Plan
HCR	Health Care Reform
HHS	U.S. Department of Health and Human Services
HIEorHIX	Health Insurance Exchange
HlM	Health Insurance Marketplace
HIT	Health Insurance Tax
HIPAA	Health Insurance Portability and Accountability Act of 1996
HRP	High Risk Pools
HRSA	Federal Health Resources and Services Administration
IFR	Interim Final Rule
MA	Medicare Advantage
MAGI	Modified Adjusted Gross Income
MEC	Minimum Essential Coverage
MedPAC	Medicare Payment Advisory Commission
MV	Minimum Value
OEP	Open Enrollment Period
PEPM	Per Employee Per Month
PMPM	Per Member Per Month
PPACA	Patient Protection and Affordable Care Act (same as ACA)
PT	Part Time
PTC	Premium Tax Credit
QHP	Qualified Health Plan
SEP	Special Enrollment Period
SHOP	Small Business Health Options Program
SSI	Supplemental Security Income
TANF	Temporary Assistance for Needy Families program

2013 Federal Poverty Guidelines and Premium Subsidies

Beginning in 2014 the amount some pay for health insurance will depend on their annual income.
 Below we have listed the Federal Poverty Level for the 48 states as well as a chart to help explain the subsidies.

48 Contiguous States and DC

Note: The 100% column shows the federal poverty level for each family size, and the percentage columns that follow respresents income levels that are commonly used as guidelines for health programs. 

Household Size	100%	133%	150%	200%	300%	400%
1	$11,490	$15,282	$17,235	$22,980	$34,470	$45,960
2	15,510	20,628	23,265	31,020	46,530	62,040
3	19,530	25,975	29,295	39,060	58,590	78,120
4	23,550	31,322	35,325	47,100	70,650	94,200
5	27,570	36,668	41,355	55,140	82,710	110,280
6	31,590	42,015	47,385	63,180	94,770	126,360
7	35,610	47,361	53,415	71,220	106,830	142,440
8	39,630	52,708	59,445	79,260	118,890	158,520
For each additional person, add	$4,020	$5,347	$6,030	$8,040	$12,060	$16,080

 From: Families USA

If you and your family are at 400% or below Federal Poverty Level you will be eligible to receive a subsidy from the government to help cover part of your private insurance premiums.  Your maximum premium will be determined as a percentage of your annual household income.

For Example: 

A single person making $35,000 per year would pay approximately $277 per month for a silver level plan.  

A single person making $17,235 per year would pay approximately $57 per month for the same plan and have a reduction in out of pocket costs.

Premium Subsidy
Income (% of FPL)	Premium as a Percentage of Income Cap	Reduction in Out of Pocket Limits
Under 133 %	2%	66.70%
150%	4%	66.70%
200%	6.3%	20%
250%	8.05%	N/A
300%	9.50%	N/A
400%	9.50%	N/A

White House delays employer mandate requirement until 2015

Today, the Obama administration announced that the employer mandate aspect of the Patient Protection and Affordable Care Act (PPACA) will be delayed by one year.

This mandate requires businesses with 50 or more workers to provide health insurance coverage to employees. As a result, the administration will start enforcing the mandate in 2015, rather than January 1, 2014, in an effort to give businesses more time to prepare. This change has come about due to the input they have received from businesses.

There will be additional changes tied to this delay, and the administration has stated that they will provide formal guidance within the next week.
We will do our best to keep you up-to-date and informed of the changes associated with the PPACA.

See the official release here:
http://www.treasury.gov/connect/blog/Pages/Continuing-to-Implement-the-ACA-in-a-Careful-Thoughtful-Manner-.aspx

Tax Considerations For 2014

Once you’ve completed your taxes this year, take a look at your income and see if you’ll qualify for a federal health insurance subsidy in 2014. If your adjusted gross income was less than 400% of the federal poverty level (that’s about $45,000 for a single person or $92,000 for a family of four, in 2012), you may qualify for a government subsidy in 2014.  Click here to calculate your subsidy. 

Failure to obtain health insurance in 2014 could result in a tax penalty. The penalty starts at $95 or 1% of income (whichever is greater) per person in 2014. It gradually rises until it hits 2.5% or $695 (whichever is greater) per person by 2016.

Another change: starting this year, you may notice a new dollar figure in Box 12 of your W-2. If you have employer-based health insurance, the cost of your coverage may be reported to the IRS here. Even though the value of your plan is reported on your W-2, it’s not taxable. So you don’t need to report it as income on your tax return.  This reporting is for the so-called “Cadillac” plans (with aggregate values of over $10,200 for individual coverage or $27,500 for families) which may be subject to an excise tax starting in 2018.

Enrollment Suspending for High Risk Health Pool

The following information is from the government website for Pre-Existing Condition Insurance Plan http://1.usa.gov/YWVY9i

Beginning February 16, 2013, the federally-run Pre-Existing Condition Insurance Plan (PCIP) is suspending acceptance of new enrollment applications until further notice. State-based PCIPs may continue accepting enrollment applications through March 2, and will then suspend acceptance of new enrollment applications until further notice. PCIP will continue providing coverage to more than 100,000 people currently enrolled nationwide. We encourage you to visithttp://finder.healthcare.gov  to explore your other health care options.

Note: If you lost PCIP coverage during the past 6 months because you moved out of state, you may be eligible to re-enroll in PCIP in your new state of residence. Please call 1-866-717-5826 (TTY: 1-866-561-1604), Monday – Friday, 8 a.m. to 11 p.m. EST, if you believe you are eligible.

Why is PCIP enrollment being suspended?

PCIP is a temporary program for those locked out of the current insurance marketplace. The program has a limited amount of funding from Congress.

Based on program experience and trends since the start of the program, PCIP enrollees have serious and expensive illnesses with significant and immediate health care needs. More information can be found in the Annual Report on the Implementation and Operation of the PCIP Program available here.

This suspension will help ensure that funds are available through 2013 to continuously cover people currently enrolled in PCIP.

The Health Insurance Marketplace

Starting next year, the Affordable Care Act guarantees that all Americans – regardless of their health status or pre-existing conditions – will finally have access to quality, affordable coverage. People will be able to apply for affordable health insurance coverage choices in Health Insurance Marketplaces when open enrollment begins on October 1. The Health Insurance Marketplace will offer a choice of quality, affordable health plans. Coverage begins on January 1, 2014. Visit www.healthcare.gov to learn more about the Marketplace.