By: Melanie Nathan
San Francisco - Six months after the Affordable Care Act was signed into law, patients and families are beginning to reap rewards. The nation’s new health care law is now delivering protections and cost benefits; yet it will affect consumers differently, and that may cause confusion. Understanding will contribute to its effective implementation and this will involve all ends of the spectrum.
The new law is to commence effectively from September 23, 2010; six months after President Obama signed it into law.
“For the older Americans with multiple health problems who rely on the system most, improving coordination and quality of care is especially critical. At long last, the new law puts that within reach. Soon, essential preventive care like blood pressure, cholesterol and diabetes screening will be free, and the building blocks will be in place to improve care coordination, reduce harmful medication interactions, prevent unnecessary hospitalizations, and improve communication among doctors and patients,” said Debra Ness, president of the National Partnership for Women & Families, which leads the Campaign for Better Care. “That is what patients – especially older adults and the families who care for them – need most. I’m optimistic that we are finally on the road to creating a health care system that works for our most vulnerable patients.” This is helping to close the donut hole for Medicare beneficiaries, creating new patient protections, making it possible for people to get better information and compare health insurance plans online, and laying the groundwork for new approaches that will improve coordination and help people get better care. ”We are especially hopeful about the increase in access to coverage for low-income families and its potential to reduce disparities. The new patient protections in the Affordable Care Act will finally mean families can get the care they need, when they need it, without fear of being denied because of their age or a pre-existing condition,” said Emily Spitzer, Executive Director of the National Health Law Program (NHeLP), a Campaign for Better Care partner. “It’s about time.”
Changes in the Law
The start of the new law depends on when your health insurance plan year starts. Many of the new requirements begin with plan years starting on or after Sept. 23. But if your plan year starts Jan. 1, as many do, that’s when the changes start.
“Grandfathered” plans, those that existed before the law was enacted March 23 and which remain essentially unchanged, must meet only some of the requirements. New plans and those with significant changes in benefits or out-of-pocket costs must comply with even more changes in the law.
If you get insurance through work, ask your employer about any changes. If you buy insurance yourself, call your insurance company.
The New Benefits
- Free preventive care is: Some will no longer have co-pays, no coinsurance nor have to meet deductibles for preventive care that’s backed up by the best scientific evidence. That includes flu vaccines, mammograms and even diet counseling for adults at-risk of chronic disease. Free preventive care is not required of existing health plans that haven’t changed significantly, such as the “grandfathered” plans we mentioned earlier. New plans, and those that change substantially on or after Sept. 23, must provide this benefit.
- If you go to an emergency room outside your plan’s network, you won’t get charged extra. Patients will be able to designate a pediatrician or an ob-gyn as their primary care doctor, avoiding the need for referrals that are required by some plans.
- Insurance that sets a cap on what insurance will pay to cover medical costs over a lifetime have been a notorious cause of unconscionable debt for very sick patients, often left with medical bills in the millions of dollars. Dollar limits on insurance coverage, whether lifetime or yearly are either eliminated completely or are being phased out by the year 2014. Under the new law, lifetime limits on most benefits are prohibited in any health plan or insurance policy issued or renewed on or after September 23, 2010.
- Annual limits will be eliminated entirely by 2014. However, employers and insurance companies can apply for waivers for so-called “mini-med” plans that offer limited benefits. The intent of the waivers is to allow these low-cost plans to exist so that people don’t lose their health coverage when premiums go up.
- Insurers can no longer deny coverage to children with pre-existing conditions. Also, parents can keep their adult children on their health plans until age 26. Companies in some states have said the new requirement to insure children with pre-existing conditions will lead to unpredictable costs. Their decision to stop selling such policies won’t affect existing plans. Most children are covered under family insurance plans. The trade group America’s Health Insurance Plans estimates about 8 percent of all plans sold on the individual market that cover one person are for people under age 18.
- The law prevents insurers from canceling policies retroactively, when a person gets very sick and runs up high bills. Insurers still will be able to rescind policies in cases of fraud and intentional misrepresentation. They, however, have no right to cut patients off when coverage is needed most, for whimsical reasons.
- The Obama administration says the new benefits will only raise premiums by no more than 1 to 2 percent. Benefit consulting companies say the impact will be in the single digits, but may vary from plan to plan.
- Mistakes or missing information on insurance policy applications are no longer grounds for rescission of the policy. If you make an honest mistake or omit information, that isn’t significant to your overall health history, companies are no longer allowed to cut off coverage. Some companies did more than that and asked for money back for benefits covered prior to discovery of the application mistake or omission.
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Sources: Associated Press Research, Employee Benefit Research Institute, eHealth Inc., Kaiser Family Foundation.