<P> The Medicare payment system switched from fee - for - service to bundled payments . A single payment was to be paid to a hospital and a physician group for a defined episode of care (such as a hip replacement) rather than individual payments to individual service providers . In addition, the Medicare Part D coverage gap (commonly called the "donut hole") was to shrink incrementally, closing completely by January 1, 2020 . </P> <P> The Act allowed the creation of Accountable Care Organizations (ACOs), which are groups of doctors, hospitals and other providers that commit to give coordinated, high quality care to Medicare patients . ACOs were allowed to continue using a fee for service billing approach . They receive bonus payments from the government for minimizing costs while achieving quality benchmarks that emphasize prevention and mitigation of chronic disease . If they fail to do so, they are subject to penalties . </P> <P> Unlike Health Maintenance Organizations, ACO patients are not required to obtain all care from the ACO . Also, unlike HMOs, ACOs must achieve quality of care goals . </P> <P> Medicare Part D participants received a 50% discount on brand name drugs purchased after exhausting their initial coverage and before reaching the catastrophic - coverage threshold . The United States Department of Health and Human Services began mailing rebate checks in 2010 . By the year 2020, the donut hole will be completely phased out . </P>

Under the affordable care act what is the role of health insurance exchanges course hero