On March 23rd, 2010, President Obama signed into law the Patient Protection and Affordable Care Act, designed to reduce health care costs for American families and small businesses, expand coverage to millions of Americans and end certain practices of insurance companies.
Although some provisions of the act do not become effective until 2014, many take effect immediately.
For example, certain persons with pre-existing conditions can get coverage this year.
If you have been uninsured for 6 months and have a pre-existing condition, you will gain access to health insurance that was not previously available to you. A new program known as the interim high-risk pool will provide insurance for Americans who are uninsured because of a pre-existing condition through a temporary subsidized high‐risk pool, to provide temporary protection for people with pre-existing conditions until 2014, at which time insurance companies can no longer deny coverage based on your health.
Effective 6 months after enactment (approximately September, 2010):
• No discrimination against children with pre-existing conditions. The law prohibits new health plans from denying coverage to children with pre‐existing conditions. Beginning in 2014, this prohibition would apply to all persons.
• Insurance companies are banned from dropping people from coverage when they become sick.
• New health plans must allow children up to age 26 to remain on their parents’ insurance policy (at their parents’ choice). Both married and unmarried dependents qualify for this dependent coverage. Beginning in 2014, children up to age 26 can stay on their parent’s employer plan even if they have an offer of coverage through their employer.
• Health insurance companies are prohibited from placing lifetime caps on coverage. Annual limits will also be restricted, and will be prohibited all together by 2014.
• New private plans must cover preventative services with no co-payments, and preventive services must be exempt from deductibles.
• Consumers in new plans must be ensured access to an effective internal and external appeals process to appeal decisions by their health insurance plan.
• New group health plans are prohibited from establishing eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees.
Other provision that become effective this year:
• The act provides a $250 rebate to Medicare Beneficiaries who hit the “donut hole” (the gap in Medicare prescription drug coverage). Beginning 2011, there will be a 50% discount on prescription drugs in the donut hole, which is to be completely closed by 2020.
• There is help for early retirees through the creation of a temporary re-insurance program (until the Exchanges are available) to help offset premiums for retirees ages 55-64.
• States will be provided aid to establish offices of health insurance consumer assistance in order to help individuals with the filing of complaints and appeals.
Beginning in 2011:
• Copayments for preventive services under the Medicare program are eliminated, and preventive services are exempt from deductibles.
• Individual and small group plans are required to spend 80 percent of premium dollars on medical services (85% for larger group plans). Insurers who do not meet this threshold must give rebates to policyholders.
• Increased funding for community health centers will allow for nearly double the number patients served by the centers over the next 5 years.
• New investments will be implemented to increase the number of primary care practitioners, including doctors, nurses, nurse practitioners, and physician assistants.
• Health insurance companies will be required to submit justification for all requested premium increases, and insurance companies with excessive or unjustified premium exchanges may not be able to participate in the new Health Insurance Exchanges.
Nothing in the health reform bill requires anyone to change their existing coverage. If you like the health plan you have, you will be able to keep it. There is also no “employer mandate” in the legislation, so your employer is not required to provide you with medical insurance, but those who do may be eligible for tax incentives.
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