ACA – Affordable Care Act – Healthcare Law that went into affect on March 23, 2010.
ACO – Accountable Care Organization – An ACO is an organization of health care providers (doctors, hospitals, etc.) that agree to be accountable for the quality, cost & overall care of Medicare beneficiaries (patients) who are enrolled in the traditional fee-for-service programs who are assigned to it.
APTC – Advance Payment of the Premium Tax Credit – This refers to the monthly amount the government will pay to the insurance company for the health insurance premium of a plan purchased through the Health Insurance Marketplace.
BHP – Basic Health Plan – A new State program that must meet certain Federal requirements and be approved by HHS. It will be available on January 1, 2015 and could be another option for individuals who can’t get Medicaid because many states have not expanded their programs. The individuals must also be eligible to purchase coverage through the Health Insurance Marketplace.
CHIP – Children’s Health Insurance Program - State run program with Federally matched funds that provides health coverage for children in families with incomes too high to qualify for medicaid, but can’t afford private coverage.
CMS – Centers for Medicare and Medicaid – The government agency that oversees Medicare, Medicaid, CHIP and portions of the ACA.
DOMA – Defense of Marriage Act – On June 26, 2006 the US Supreme Court rules that domestic partners must be treated the same as a spouse in States that recognize same-sex marriages. The repeal of DOMA impacts the possible subsidy available to domestic partners under the ACA.
EHBs – Essential Health Benefits – Refers to the package of benefits that must be offered by certain health plans under the Affordable Care Act.
FTEs - Full time Equivalent Employee – Refers to Employees who do not work on average 30 hours per week (or 130 hours per month) but are included in the calculation to determine if an employer is considered a large employer under the ACA.
FPL -Federal Poverty Level – This government measurement is used to determine eligibility for tax credits and out-of-pocket cost reductions in the Health Insurance Marketplace plans. It is also used in determining eligibility for other government programs such as Medicaid and CHIPs.
HCR – Health Care Reform – Acronym sometimes used to refer to the Affordable Care Act
HHS – Health and Human Services Department - the Secretary of the HHS is the person responsible for coordinating the development of the regulations for the ACA and is also responsible for overseeing the implementation and on-going operation of the various aspects of the law.
MAGI – Modified Adjusted Gross Income – The figure that will be used by the IRS to determine the amount of premium tax credit and/or reduction of out-of-pocket expenses that will be available to an individual under the Affordable Care Act.
MEC – Minimum Essential Coverage – type of health coverage required for an individual to avoid paying a penalty.
MLR – Medical Loss Ratio – Measurement used to ensure that a percentage of the premiums paid to insurance companies are used to pay for claims.
OOP – Out-of-Pocket Expense – Refers to the amount of money that an individual must pay without receiving any reimbursement from the insurance plan. This includes the deductible, co-insurance, co-payments and balance billing payments.
PCOR – Patient-Centered Outcomes Research Fee – applies to a fees paid by the employer or the insurance company and is required for health insurance plans (including self-insured plans) from 9/30/2012 to 9/30/2019.
PPACA – Patient Protection and Affordable Care Act – Official title of the healthcare law that went into affect March 23, 2010.
QHP – Qualified Health Plan – Refers to an insurance plan that has been approved to be offered in the Marketplace.
SHOP – Small Business Health Options Program – Refers to the insurance plan(s) that will be available to small employers in the Health Insurance Marketplace.