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Individuals and the Affordable Care Act

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Clinicians and the Affordable Care Act

Many provisions of The Affordable Care Act are already in place, with more significant changes coming in 2014.  The law enacts comprehensive reforms that benefit clinicians.

Top 5 Ways You and Your Practice Benefit from the Affordable Care Act:

  1. Expanded insurance coverage to more than 34 million people, resulting in more patients for your practice. The law eliminates exclusions based on pre-existing conditions and extends affordable health coverage to over 34 million uninsured Americans in 2014. This will reduce the burden of uncompensated care on physicians and hospitals and bring more patients into your practice.
  2. Reduced administrative burdens and more time seeing patients. The law invests in programs designed to help you and your practice transition to electronic record systems. We’re working with your professional organizations to support new payment and record-keeping systems, with the goal of reducing administrative burdens. This will let you to spend more time in the exam room, and less on paperwork.
  3. New models create more opportunities to coordinate care. We’re working to develop new models of patient-centered, coordinated care designed to give you more support and control: faster information flow across care sites, better consults, and provider support systems that help patients become active participants in their care. And Medicare pays bonuses to qualified primary care doctors.
  4. New consumer protections hold health insurers accountable, putting patients and clinicians first. Insurers can’t cancel coverage when a patient gets sick, and they can’t set lifetime benefit limits that leave patients without coverage in times of catastrophic need. Insurers that don’t spend at least 80% of premium dollars on patient care have to provide rebates to consumers. Read more about consumer protections.
  5. New protections strengthen patient coverage, your practice, and the entire health care system. The Affordable Care Act preserves guaranteed benefits under Medicare; makes recommended preventive services for people with Medicare available at no cost; and provides patients with an annual wellness visit. The law also requires insurers to cover an expanded list of preventive services for many people with private insurance for free. As a result, patients will be able to afford both routine preventive care and necessary treatments.
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Families with Children and the Affordable Care Act

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Health Insurance -

Affordable Care Act

The 2010 Affordable Care Act will reform health insurance, over several years. Some new provisions are already in place; most changes will take effect by 2014. This law holds insurance companies more accountable, expands coverage for young adults, offers small-business tax credits, and provides access to insurance for uninsured Americans with pre-existing conditions.


States decide on the benefits provided under Medicaid, but Medicaid usually provides health care for low-income children and families, and people with disabilities. Covered services usually include doctor visits, hospital care, vaccinations, prescription drugs, vision, hearing, long-term care, and preventive care for children.


Medicare is a government health insurance plan for people 65 or older, people under 65 with certain disabilities, and people with end-stage renal disease. Medicare helps to pay for care in hospitals, skilled nursing facilities, hospice care, and some home health care. Coverage can also include doctors’ services and prescription drugs.
  • Medicare – Learn about the Medicare program; enroll online; and find a Medicare-enrolled doctor or health care facility.
  • Replace Your Medicare Card – If your Medicare card is lost, stolen, or damaged, you can ask for a new one online.

Health Insurance for Children: CHIP

The Children’s Health Insurance Program (CHIP) provides free or low-cost health coverage for low-income children. Each state decides on the benefits provided under CHIP, but all states cover routine check-ups, immunizations, hospital care, dental care, and lab and x-ray services.

COBRA: Keep Your Insurance If You Leave Your Job

The Consolidated Omnibus Budget Reconciliation Act (COBRA) can help you temporarily keep your health insurance even though you left your job. Eligibility for the program is based on the reason you left your job, and even if you get to keep your insurance, you may be required to pay the entire premium for coverage.
  • COBRA – Learn more about the costs and benefits of the COBRA program.
  • An Employee's Guide to Health Benefits Under COBRA – This booklet explains your rights under COBRA to a temporary extension of employer-provided group health coverage, called COBRA continuation coverage.

How to Appeal a Health Insurance Claim

If your health insurer has denied coverage for medical care you received, you have the right to appeal the claim, and ask that the company reverse that decision. You can be your own health care advocate. Follow these five steps:
  1. Review your policy and explanation of benefits.
  2. Contact your insurer and keep detailed records of your contacts (copies of letters, time and date of conversations).
  3. Request documentation from your doctor or employer to support your case.
  4. Write a formal complaint letter explaining what care was denied and why you are appealing through use of the company's internal review process.
  5. If the internal appeal is not granted through step four, file a claim with your state's insurance department.
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Health insurance

 Health insurance

Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care and health system expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is available to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity C1
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