About the Affordable Care Act (ACA)

Affordable Care Act (ACA) basics
What the ACA means to Ardent
Why the U.S. health care system needed change
Health Insurance Marketplace—“Exchanges”
What you can do to help keep costs down

Affordable Care Act (ACA) basics

Health care reform changes some important things in the health care system that, because Ardent already provides generous medical coverage, you may not have known were missing.

  • Nearly everyone can get coverage. You rely on your health insurance, especially when you’re managing a health issue. It might sound strange to you if you’ve been on our plan for a long time, but some Americans were either locked out of buying medical insurance because of an illness—or couldn’t get help paying bills related to that illness for a significant period of time. As of January 1, 2014, all Americans can join any medical plan without any exclusions for pre-existing health issues.
  • Nearly everyone must get coverage. Now that the door is open to everyone, there’s no reason not to get coverage. In fact, starting January 1, 2014, everyone must have medical coverage or pay a new tax. There are regulations on the kind of plan you must have—but all Ardent’s medical plans meet all regulations. So, as long as you stay in an Ardent-provided medical plan, you’ll meet the minimum requirements for affordable coverage.
  • No more limits. When you’re really sick, bills can add up. And emotional stress can be really high. That’s why we never cap our share of your bills—as long as you’re still juggling bills, the plan features are still in effect. But now all Americans will have this kind of financial security too. Specifically, there are no annual or lifetime limits on essential health benefits.

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What the ACA means to Ardent

While the ACA addresses some issues, at the same time, this law imposes many new requirements on employers. Health care reform impacts Ardent in three main ways.

  1. Our plans will be more heavily regulated. Health care reform puts in place a laundry list of new administrative rules that we have to monitor. These rules translate into more resources we must spend to comply with the rules. In other words, we must divert some resources that can’t be spent on employees.
  2. We have new costs. New taxes on large employers, as well as indirect taxes levied on insurance companies and medical equipment providers, also mean higher overall costs for our plans.
  3. The health care landscape will keep changing. At the same time health care reform happened, new companies have emerged to help you interact with the health care system in a better way. We believe these shifts will bring new opportunities for us to provide you with more valuable benefits, so we’ll be monitoring them closely.

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Why the U.S. health care system needed change

Despite offering patients the latest medical breakthroughs and access to world-class technology, our country’s health care system needed to evolve. Why?

  • We require more care. Even with our first-world resources, Americans aren’t that healthy. Many of us—from children to middle-age adults—have chronic conditions that require regular doctor visits or daily prescriptions. Aging Baby Boomers, who are more susceptible to injury and illness, make up a large percentage of the overall population, adding to demand for care.
  • Too much care, and not always the right care, is common. The price of a common surgery can vary by thousands of dollars. When prices vary so much, it’s natural to assume that the difference is between services that cut corners and services that cover all the bases. But without clear data on the best, most cost-effective treatments, it’s hard for doctors or patients to make good decisions. Experts, including physicians, say some patients receive health care they don’t need.
  • The system is imperfect—in a number of ways. First, the payment system isn’t facilitating efficient or effective care—and leads patients down a very fragmented path to health. Doctors aren’t paid to coordinate patient care. Second, patients don’t always seek care at the most efficient or effective spot. The most common example is overuse of the emergency room for routine care, but doctor shortages and too many specialists also contribute to the problem. Third, payment is extremely complex—for the most part, patients who “purchase” the care aren’t the ones paying the lion’s share of the bills. So, when insurance companies, hospitals or provider groups consolidate, normal market forces don’t work at their best.
  • Insurance regulation and tax policy have unintended consequences. As you know, your medical plan contributions are deducted from your paycheck before taxes—a tax break that isn’t available to Americans who have individual coverage. This uneven playing field distorts costs. At the same time, malpractice suits cause many professionals to practice medicine in a defensive way—ordering tests and procedures not always because they believe they’re necessary, but instead to protect themselves against liability.

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Health Insurance Marketplace—“Exchanges”

In the past few years, you've probably heard a lot about the Health Insurance Marketplace, also called “exchanges.” Exchanges are intended for people who can’t get affordable coverage through their employer and also for small businesses. You can shop in the marketplace. Since you have affordable coverage available through Ardent, you may not find a better deal on the exchange.

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What you can do to help keep costs down

Understanding health care reform will take time. Even as you are absorbing what the law means to you and your family, you can take actions to improve your health—and save money.

  • Take care of yourself. Participate in the Bravo Wellness Program to get rewarded for getting and staying healthy. And make sure you and your family members get appropriate preventive care.
  • Take advantage of the resources Ardent has to offer to better understand your benefits, including Choosing Wisely health care resources from Consumer Reports. 

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