Affordable Care Act (ACA)
The Affordable Care Act (ACA) provides coverage to individuals and families who do not have access to employer-sponsored insurance and/or are not eligible for government programs (Medicare, Medicaid, Federal Employee Program, etc). The health care law has offered a host of coverage changes and opportunities beginning in 2014. Blue Cross and Blue Shield of Texas (BCBSTX) is committed to implementing coverage changes to comply with ACA requirements and to better meet the needs and expectations of you and your patients.
This section offers updated information and resources to keep you informed of the issues potentially affecting the administrative and patient care aspects of your practice. We invite you to refer back to this page often for ongoing information on ACA provisions.
Overview
Initial provisions of the Affordable Care Act (ACA) were implemented in March 2010. Additional provisions were enacted in subsequent phases through 2018. The individual mandate tax penalty which requires individuals to have health coverage or pay a fee began January 1, 2014. As of the 2019 coverage year, the penalty is no longer enforced. Learn more.
Individual Mandate Repeal
In 2014, most U.S. citizens and legal residents had to maintain a minimum level of health coverage or pay a federal tax penalty. The tax penalty was assessed according to a percent of income or a flat fee, whichever was greater, and was applied on federal income tax returns.
In 2017, Congress repealed the individual mandate tax penalty effective in 2019. There is now no federal tax penalty for not maintaining health coverage.
Administrative Simplification
Under the multiphase initiative known as Administrative Simplification, health plans are required to implement new operating rules to promote greater uniformity in the exchange of electronic health care information. Blue Cross and Blue Shield of Texas (BCBSTX) implemented operating rules for the first and second phases in January 2013. System changes are currently in progress for the next phase. Learn more.
Patient Perspective
As a result of the ACA law, individuals and families will have more options for managing their health care needs with expanded coverage for women, children and individuals with pre-existing conditions. Other provisions offer greater access to preventive care services with no cost sharing, and guarantees coverage of essential health benefits in our individual and small group insurance products. Learn more.
Risk Adjustment
Risk Adjustment, under ACA, identifies the differences in health care risk among specific patients. The goal of the Risk Adjustment methodology is to provide an objective way to compare care and cost performance. Providers play an important role. Risk Adjustment is one of the methods that helps payers and providers focus on quality and service. Learn more .
