Health Care & Chronic Pain: Drug & Claims Timeline through January 2011

Karen Lee Richards Health Guide
  • If you're like me, you've been wondering just how the new Health Care Reform Act will affect you and when you will see the changes.  I kept hearing that many of the benefits for patients will not happen until 2014 or later.  Although that is true, I was pleasantly surprised to discover that there are several features which will take effect much sooner. 

    Below, in order of date, are the features that will take effect within the next year.  (Note: The bill was signed into law on March 23, 2010.)

     

    Effective in fiscal year 2010 (October 1, 2009 - September 30, 2010):

    • States will receive aid to establish offices of health insurance consumer assistance to help people file insurance complaints and appeals.
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    • The government will invest in training programs aimed at increasing the number of primary care doctors, nurses and public health professionals.
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    • Increased funding will be given to community health centers, which should almost double the number of patients seen over the next five years.

    Effective for calendar year 2010:

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    • Medicare Part D recipients who hit the "donut hole" in 2010 will receive a $250 rebate.  (The donut hole will be completely closed by 2020.)
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    • Tax credits of up to 35% of premium costs will be available to small businesses who choose to offer health coverage to employees.  (The credit will go up to 50% in 2014.)

    Effective 90 days after enactment (June 21, 2010):

    • Americans who cannot get insurance due to a pre-existing condition can access insurance through a temporary high-risk pool.
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    • A temporary reinsurance program will be created to help offset the cost of expensive health claims for employers who provide health benefits for retirees between the ages of 55 - 64.  (This is to cover the period of time until the insurance Exchanges are available.)

    Effective 6 months after enactment (September 23, 2010):

    • New group health plans will be prevented from establishing eligibility rules that discriminate in favor of higher-wage employees.
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    • Parents can choose to keep their children on their health insurance plan until their 26th birthday.
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    • New insurance plans must ensure that policy holders have access to effective internal and external appeals processes if they want to appeal decisions made by the insurance company.
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    • New private plans will be required to cover preventive services with no copayments or deductibles.  (This will apply to all plans beginning in 2018.)
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    • New insurance plans will have tight restrictions regarding placing annual limits on coverage.  The specifics of the restrictions will be determined by the U.S. Department of Health and Human Services.  (Starting in 2014, all plans will be prohibited from imposing annual limits.)
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    • Health plans will not be allowed to place lifetime caps on coverage.
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    • Health plans will not be allowed to exclude children with pre-existing conditions.
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    • Health plans will not be allowed to drop anyone's coverage when they get sick.  (Beginning in 2014, no one can be denied coverage for a pre-existing condition.)

    Effective January 1, 2011:

    • A long-term care insurance program will be created that will provide around $50 a day for home care to help the elderly and disabled stay in their own homes.  Premiums will automatically be deducted from workers' paychecks unless they opt out of the program.
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    • Individual and small group insurers will be required to spend 80% of premium dollars received on medical services; large group insurers must spend 85%.  Insurance companies that do not meet those thresholds must give rebates to their policyholders.
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    • Medicare recipients will not have to make copayments for preventive services nor will preventative services fall under deductibles. 
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    • Medicare Part D recipients will receive a 50% discount on brand-name drugs that fall in the donut hole.

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    Source:  Key healthcare act provisions that take effect immediately. Medscape Today. March 30, 2010.

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Published On: March 30, 2010