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What are the 4 health mandates and why are they important in the continuity of care?

  1. What are the 4 health mandates and why are they important in the continuity of care?
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#. Health mandates :-

1. Individual mandate- requires all U.S. citizens to have insurance to cover the "essential benefits" standard. Those who do not receive a tax penalty.

2. Employer Mandate- employers with 50+ employees face a financial penalty if their employees are not enrolled in an employer-sponsored health plan.

3. Medicaid eligibility expansion (2014)- eliminated the categorical eligibility requirement and requires that states make all residents below 133% FPL eligible for Medicaid programs. Government pays 100% of Medicaid costs with states contributing 10% in 2016.

4. Insurance market regulation- requires that private health insurance plans allow dependents on plan until 26 years. It also eliminates caps on total insurance benefits payouts, denial of coverage based on pre-existing conditions, etc.

States have mandated benefits coverage requirements; state laws may require health plans to cover the costs of certain defined types of care and medical services as well as services provided by certain types of providers

#. Essential Health Benefits under the ACA :-

Ambulatory patient services

Emergency services

Hospitalization

Maternity and newborn care

Pediatric services

Prescription drugs

Laboratory services

Chronic disease management

Rehabilitative and habilitative services and devices

#. Without the mandate, sicker people would seek coverage while healthier people might avoid it, thereby increasing the cost of coverage (money paid in by healthy people covers the costs for sicker people

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