{"id":51,"date":"2013-04-30T11:06:29","date_gmt":"2013-04-30T15:06:29","guid":{"rendered":"http:\/\/www.hnetalk.com\/hcr\/?p=51"},"modified":"2013-04-30T11:06:29","modified_gmt":"2013-04-30T15:06:29","slug":"a-guide-to-acronyms-and-terminology-in-health-care-reform","status":"publish","type":"post","link":"https:\/\/hnetalk.com\/broker\/2013\/04\/30\/a-guide-to-acronyms-and-terminology-in-health-care-reform\/","title":{"rendered":"A Guide to Acronyms and Terminology in Health Care Reform"},"content":{"rendered":"

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Federal healthcare reform has brought a large number of terms and acronyms \u2013\u00a0some new and some old \u2013 into regular use in the news and in discussions about health care\u00a0and health insurance. Here are some of the more commonly used ones and an explanation of\u00a0what they mean:<\/span><\/p>\n

ACA or PPACA<\/strong> \u2013 Patient Protection and Affordable Care Act. The 2010 federal law that has\u00a0changed many of the rules about health care and health insurance across the country.<\/p>\n

ACO<\/strong> \u2013 Accountable Care Organization. A group of health care providers that has assumed\u00a0responsibility for the care of a specific group of patients and that is eligible to receive financial\u00a0incentives for improving the quality and efficiency of that care.<\/p>\n

APTC<\/strong> \u2013 Advance Premium Tax Credit. Tax credits that will be available to individuals and\u00a0families who purchase their health coverage on an Exchange and whose income is between\u00a0200 and 400 percent of the Federal Poverty Level. These are designed to make it more\u00a0affordable for people who do not have employer-provided health coverage to purchase health\u00a0coverage.<\/p>\n

AV<\/strong> \u2013 Actuarial Value. The proportion of medical expenses an insurance plan is expected\u00a0to cover.<\/p>\n

CCIIO<\/strong> \u2013 Center for Consumer Information and Insurance Oversight. An agency within HHS\u00a0that is responsible for overseeing the implementation of the provisions of the ACA related to\u00a0private health insurance.<\/p>\n

CHIP<\/strong> \u2013 Children\u2019s Health Insurance Program. A federal program that provides health coverage\u00a0to children in families with incomes too high to qualify for Medicaid but who can\u2019t afford\u00a0private coverage.<\/p>\n

CMS<\/strong> \u2013 Center for Medicare and Medicaid Services. The agency within HHS that administers\u00a0and oversees both the Medicare and Medicaid programs.<\/p>\n

CO-OP<\/strong> \u2013 Cooperative Health Plan. A qualified non-profit health plan authorized by the ACA to\u00a0sell QHPs primarily through an Exchange.<\/p>\n

CSR<\/strong> \u2013 Cost Sharing Reduction. Subsidies available to individuals and families who purchase\u00a0their health coverage on an Exchange and whose income is between 200 and 300 percent of\u00a0the Federal Poverty Level. These are designed to help eligible individuals pay copays,\u00a0deductibles, and coinsurance.<\/p>\n

EHB<\/strong> \u2013 Essential Health Benefits. The categories of benefits that all health plans in the\u00a0individual and small group markets must provide. Under the ACA, those categories are:\u00a0ambulatory patient services; emergency services; hospitalization; maternity and newborn care;\u00a0mental health and substance use disorder services; prescription drugs; rehabilitative and \u00a0habilitative services and devices; laboratory services; preventive and wellness services and\u00a0chronic disease management; and pediatric services, including oral and vision care. All\u00a0benefits that were mandated by Massachusetts prior to December 31, 2011 are also included\u00a0in EHB. The ACA requires that EHBs are not subject to annual dollar limits.<\/p>\n

EXCHANGE<\/strong> \u2013 An online marketplace where individuals and small employers can purchase\u00a0health coverage. Most government subsidies are only available through an Exchange. The\u00a0Health Connector Authority will operate the Massachusetts Exchange.<\/p>\n

FPL<\/strong> \u2013 Federal Poverty Level. The set minimum amount of gross income a family needs for\u00a0food, clothing, transportation, shelter and other necessities. Under the ACA, individuals and\u00a0families with modified adjusted gross income up to 400% of FPL can receive subsidies to pay\u00a0for health coverage. The amount of the subsidy decreases as income increases.<\/p>\n

FSA<\/strong> \u2013 Flexible Spending Account. A special account that allows an employee to set aside pretax\u00a0wages to be used for various expenses, including copays and deductibles. Funds in an<\/p>\n

FSA<\/strong> must be used during the benefit year or the employee loses the funds.<\/p>\n

FTE<\/strong> \u2013 Full Time Equivalent. The number of working hours that represent one full-time\u00a0employee during a time period. For purposes of the ACA, FTE is 30 hours per week.<\/p>\n

HHS<\/strong> \u2013 Department of Health and Human Services. The federal cabinet-level department that\u00a0administers federal health, welfare, and human services programs and activities.<\/p>\n

HIT<\/strong> \u2013 Health Insurance Tax. An annual fee to be paid by the issuers of insured health plans\u00a0beginning in 2014. In 2014, the total fee nationwide will be $8 billion; the fee will increase in\u00a0later years. The fee does not apply to self-insured health plans.<\/p>\n

HRA<\/strong> \u2013 Health Reimbursement Account or Health Reimbursement Arrangement. An employer funded,\u00a0tax advantaged health benefit plan that reimburses employees for out of pocket\u00a0medical expenses not covered by the employer\u2019s standard health coverage. Any unused funds\u00a0remain with the employer.<\/p>\n

HSA<\/strong> \u2013 Health Savings Account. A special account that allows an employee who is enrolled in\u00a0a high deductible health plan to set aside pre-tax wages to be used for qualifying medical\u00a0expenses, including copays, deductibles, and coinsurance. Funds in an HSA belong to the\u00a0employee and can roll over from year to year.<\/p>\n

MAGI<\/strong> \u2013 Modified Adjusted Gross Income. Generally, your adjusted gross income plus any tax-exempt\u00a0interest income. Under the ACA, MAGI will be used to determine eligibility for Medicaid\u00a0or federal subsidies such as APTCs and CSRs.<\/p>\n

MEC<\/strong> \u2013 Minimum Essential Coverage. The level of coverage that a large group health plan\u00a0must provide. For a plan to provide MEC, it must have an AV of 60. Failure to provide MEC\u00a0could cause a large employer to be subject to tax penalties.<\/p>\n

MLR<\/strong> \u2013 Medical Loss Ratio. The proportion of a health plan\u2019s premium revenues that is spent\u00a0on medical care and quality of care improvement expenses. In 2014, each health plan\u2019s MLR\u00a0must be at least 88%. If a health plan does not meet this standard, it will have to pay rebates to\u00a0its members.<\/p>\n

OOPM<\/strong> \u2013 Out-of-Pocket Maximum. The yearly maximum amount your health coverage requires\u00a0you to contribute toward the cost of your health care. Under the ACA, all types of cost-sharing\u00a0(copays, deductibles, and coinsurance) for EHBs must be included when calculating your out-of-pocket total.<\/p>\n

PCORI<\/strong> \u2013 Patient-Centered Outcomes Research Institute. A special federal authority created\u00a0by the ACA to advance the quality and relevance of research initiatives that can be used to\u00a0help patients, providers, purchasers, and policymakers make informed health care decisions.<\/p>\n

QHP<\/strong> \u2013Qualified Health Plan. A health plan offered in the individual and small group market\u00a0that provides EHB and an AV of either 60 % (bronze plan), 70% (silver plan), 80% (gold plan)\u00a0or 90% (platinum plan). QHPs may be sold both inside and outside of an Exchange.<\/p>\n

SHOP<\/strong> \u2013 Small Business Health Option Program. The Exchange where small employers can\u00a0purchase health insurance for their employees beginning in 2014. The Health Connector\u00a0Authority will operate the SHOP in Massachusetts.<\/p>\n

3Rs<\/strong> \u2013 Risk Adjustment, Risk Corridors, and Transitional Reinsurance. Three programs\u00a0established by the ACA to help spread the financial risks to health plans caused by providing\u00a0health coverage to a large number of previously uncovered individuals, many of whom will\u00a0incur high health care costs.<\/p>\n

TRF<\/strong> \u2013 Transitional Reinsurance Fee. A temporary fee established by the ACA that will fund a\u00a0program to protect QHP issuers against unpredictably high medical claims. The fee will be\u00a0imposed on health plan issuers and self-insured health plans from 2014 through 2016.<\/p>\n

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Federal healthcare reform has brought a large number of terms and acronyms \u2013\u00a0some new and some old \u2013 into regular use in the news and in discussions about health care\u00a0and health insurance. Here are some of the more commonly used ones and an explanation of\u00a0what they mean: ACA or PPACA \u2013 Patient Protection and Affordable […]<\/p>\n","protected":false},"author":1,"featured_media":88,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[33,35],"tags":[],"class_list":["post-51","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-affordable-care-act","category-hcr"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/hnetalk.com\/broker\/wp-content\/uploads\/2013\/04\/HNElogo.png","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZOS-P","_links":{"self":[{"href":"https:\/\/hnetalk.com\/broker\/wp-json\/wp\/v2\/posts\/51","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hnetalk.com\/broker\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hnetalk.com\/broker\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hnetalk.com\/broker\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hnetalk.com\/broker\/wp-json\/wp\/v2\/comments?post=51"}],"version-history":[{"count":0,"href":"https:\/\/hnetalk.com\/broker\/wp-json\/wp\/v2\/posts\/51\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/hnetalk.com\/broker\/wp-json\/wp\/v2\/media\/88"}],"wp:attachment":[{"href":"https:\/\/hnetalk.com\/broker\/wp-json\/wp\/v2\/media?parent=51"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hnetalk.com\/broker\/wp-json\/wp\/v2\/categories?post=51"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hnetalk.com\/broker\/wp-json\/wp\/v2\/tags?post=51"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}