- Estimated 32 million new enrollees
- Accountable Care Organizations (ACOs) – services all in-house with fiscal and performance targets. Federal financial incentives if goals met.
- Coverage cannot be denied for pre-existing conditions.
- Employers with > 50 full-time employees must provide health insurance.
- Wellness model – no copays for annual health appraisals and immunizations.
- Organizations will be incentivized or penialized based on patient outcomes.
- Institutions will not receive any reimbursements for preventative readmissions or any acquired disease/condition during hospital stay (e.g., nosocomial pneumonia).
- Parents may keep children on plans until the age of 26.
- Consumers can expect higher wait times for preventative and speciality care services.
- More stringent utilization review practices for high cost procedures such as MRIs, CTs, non-life threatening surgeries.
- Health care exchanges offer private insurance policies to consumers if they are not covered by employers.
- Resources: Kaiser Family Foundation, www.medicare.gov