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Q. I've heard so much about health care reform (Affordable Care Act), but I'm not sure exactly how I will be affected?

A.

Many of the prominent provisions of The Patient Protection and Affordable Care Act will not take effect until January 1, 2014. However, significant changes occurred in 2010 and 2011. Here’s a summary with highlights:

June 2010:

• People with pre-existing conditions who have been uninsured for 6 months or more are able to purchase insurance coverage through the Pre-Existing Condition Insurance Plan. Some people may also be eligible for subsidized premiums.

September 2010:

• Existing insurance plans are barred from imposing lifetime limits on coverage. Annual limits on coverage will end in January 2014.
• Insurers are prevented from canceling coverage retroactively (for example, if the policy holder gets sick).
• Insurers are allowed to exclude coverage of pre-existing medical conditions for children under age 19.
• Dependent children are able to remain on their parents' health insurance until the age of 26.
• Medicare recipients who are in the Part D “doughnut hole” receive a $250 rebate.
• All new insurance policies must cover certain preventive screenings, such as breast, cervical, and colorectal cancer screenings, as well as flu shots and immunizations, without charging a deductible, co-pay or co-insurance. *Please note that diagnostic screenings are not covered under this provision.
• Generics are approved within 12 years of patent.
• More funding is available to compare the effectiveness of medical treatments.
• A new division, the Federal Coordinated Health Care Office, improves coordination of care for those who receive both Medicare and Medicaid.

During 2011:

• Medicare recipients who are in the Part D “doughnut hole” receive a reduction in cost of 50% on brand-name drugs.
• Certain types of preventive care are available to Medicare and Medicaid recipients at no cost.

Looking forward to 2014:

• Insurers will not be able to refuse coverage to anyone with a pre-existing condition.
• State-run insurance “exchanges” will offer insurance policies to people who don’t get their coverage through an employer or a government- subsidized program. Those who buy insurance through an exchange and have low-to-moderate incomes will be eligible for subsidies to pay for their premiums.
• More people will be eligible for Medicaid.
• Most (but not all) people will be mandated to have coverage, and a penalty will apply if you don’t.
• All new plans must offer an essential benefits package, including coverage for hospitalization, doctor visits, laboratory services, and medications, with limits on your out-of pocket costs.

Other comprehensive sources of information include The Kaiser Family Foundation and The Medicare Rights Center. Healthcare.gov is the federal government’s consumer-friendly website providing more details on health care reform, as well as current and future coverage options.

Answered by
Renata Marinaro, LMSW

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Tags:insurance affordable care act