The main components of the Affordable Care Act (ACA) used to expand coverage to the uninsured are the Health Insurance Marketplaces and Medicaid Expansion. Health insurance coverage offered to beneficiaries of plans in the Marketplaces or through Medicaid expansion must include coverage for all essential health benefits, which include rehabilitation and habilitation.
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Essential Health Benefits (EHBs)
Essential Health Benefits (EHBs) are a package of benefits that assure certain health plans offered in the state Health Insurance Marketplaces provide a baseline of coverage, benefits, and services to their enrollees. Most health plans that will be offered in Marketplaces, with some exceptions, must cover these benefits in order to be certified and offered in the Marketplaces. Additionally, designated groups of newly eligible Medicaid beneficiaries through Medicaid expansion must also receive these benefits by 2014. EHBs include rehabilitation and habilitation services.
Health Insurance Marketplaces
Health insurance marketplaces, or exchanges, are a fundamental component of the ACA. Section 1311 of the ACA created the "exchanges" to provide competitive marketplaces for individuals and small employers to directly compare available private health insurance options on the basis of price, quality, service, and other factors. The primary purpose of the Marketplaces is to enhance competition in the health insurance market, improve choice of affordable health insurance, and give small business the same purchasing clout as large business. The Marketplaces will become operational in every state by January 1, 2014.
Medicaid is the nation's health insurance program for low-income individuals and families. The ACA calls for a nationwide expansion of Medicaid eligibility, set to begin in 2014. As the law was written, nearly all US citizens under 65 with family incomes up to 133 percent of the federal poverty level (FPL) ($30,675 for a family of four in 2012) will qualify for Medicaid under the expansion.
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