Health Care Reform: How Does It Benefit You?

Carrie Beth Brown Health Guide
  • With the elections over and the new health care reform bill moving forward, there is a lot of talk and speculation about the new rules and regulations. As someone who lives with multiple chronic health issues, like Rheumatoid Arthritis, I'm very excited to see the changes that are coming our way! There are some great resources out there already on the internet but I wanted to help our community members here on HealthCentral get a quick overview of the changes that are happening with the passing of this new bill. Most of these changes are specific to private or individual health insurance and not Medicare or Medicaid unless noted.

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    No Policy Cancellations - Insurance companies can no longer cancel your policy if you get sick, end up in the hospital or have any kind of new medical diagnosis or health crisis. That's right, your coverage cannot be cancelled for any reason!


    No More Lifetime Limits - In the past, insurance companies could put a limit on the maximum amount they would pay for your medical bills. This is now illegal and ALL lifetime maximums have been changed to "unlimited" for everyone. Please note that until January 2014, insurance companies can still set limits on how much they will pay for an individual's medical expenses per YEAR, but this limit must be no less than $2 million. After January of 2014, these limits will be eliminated. This is a huge benefit for so many people with major or long-term illnesses.


    Faster Appeals - If you are experiencing an urgent medical situation and need to appeal a decision made by your insurance company on care, you have the right to receive an independent review and a response with 72 hours.


    Free Preventative Care & Annual Checkups - All new private health plans must cover the entire cost of yearly prevention checkups for individuals. These include yearly physical exams, immunizations, cancer screenings, pap smears, and "well woman" visits. Some existing plans may continue to charge for preventative care until 2014, but only if the plan hasn't changed since the passage of the law.


    Young Adults Covered Until Age 26 - Young adults can now stay on their parents’ insurance policies as dependents until they turn 26, regardless of whether they attend school, live at home or are married. Note: there may be an exception if a young adult is provided coverage through their place of work. This exception goes away in January 2014. This change means an estimated 6.6 million young adults, who would have otherwise gone uninsured, will be covered within the next year.


    Pre-existing Conditions - The new law has created a temporary program to help any adult who has been without insurance coverage for at least six months through the "Pre-Existing Condition Insurance Plan" (PCIP) in their state. Visit the PCIP website for more information and to see if you qualify. Note that as of January 2014, insurance companies CANNOT deny anyone coverage or charge more for premiums because of pre-existing conditions.


    Rebates on Premiums - The new health care law requires that insurance companies must spend 80-85 percent of the premiums you pay on medical care and quality improvements. If they spend too much on things like salaries, bonuses or administrative costs, they have to issue rebates to their customers. Some people may have already seen rebates notices letting them know they are due a rebate next year.


    Standard Benefit Formatting - Have you ever tried to compare plans and had trouble finding the same info on both plan documents? Starting in September 2012, the health care reform bill mandate that all insurance companies must use a standardized, easy to understand format to disclose all benefits and coverage in their health plans. In addition, all excluded services must be listed in one place and your insurance company must give you a sample out-of-pocket cost for two medical scenarios. At present, the two scenarios are treating type 2 diabetes and having a baby. Additional sample costs will be included in future years.

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    No More Pre-existing Condition Denials - One of the biggest and best changes in the new law that takes effect onJanuary 1, 2014. You can no longer be denied coverage by any insurance company because of a pre-existing condition! They also cannot charge you a higher rate because of any pre-existing condition or your gender. The insurance companies will have to give you the same rate as anyone else your age. You will now be able to buy health insurance even if you are seriously ill.


    Online Insurance Marketplaces - As of January 2014, all individuals, families and small business will be able to view, compare and purchase health insurance from online marketplaces called "exchanges". The marketplaces will open for business on October 1, 2013 and sell coverage that starts on January 1, 2014.


    Discounts for Insurance Premiums - Discount programs will be offered to help people pay for private insurance premiums if their out-of-pocket cost is too high. In addition, individuals may qualify for extra subsidies to help with costs for government programs like Medicare, Medicaid and Children's Health Insurance Plan. The new marketplaces will have tools to help you determine if you qualify for financial assistance.


    Minimum Level of Coverage - All insurance plans sold to individuals and small businesses must offer a minimum level of benefits and comprehensive plans starting onJanuary 1, 2014. These benefits include: emergency services, hospitalizations, maternity care, laboratory services, prescription drugs, pediatric care, preventive care, mental health and substance abuse treatment, outpatient/ambulatory care, rehabilitative and habilitative (helping maintain daily functioning) services, vision and dental care for children.


    The new health care law brings a lot of new changes that can benefit us all in the coming years. It's not possible to cover ALL the benefits and changes in this post - if you would like to read more about the health care bill, please visit the new website. There you will be able to find out what kind of insurance you qualify for right now, more information on understanding health insurance in general, as well as get in-depth info on everything related to the new health care changes! 


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    Carrie Beth Brown is the author of the blog Dancing in the Rain.


Published On: December 11, 2012