AFFORDABLE CARE ACT WILL CHANGE HEALTH CARE FOR EVERYONE

With the opening of the health care exchange next week, we have heard a lot about the new services that will be available for people who need insurance. But what about people who are already insured?

It is important to understand that the inception of the Affordable Care Act will affect everyone, regardless of what type of insurance they have now.  Everyone will benefit from new rights and protections that start January 1, 2014.  These include:

  • An end to lifetime limits. Insurance companies can’t cap the amount they spend on your health benefits throughout the life of your policy.
  • An end to yearly limits. For policies starting after January 1, providers won’t be allowed to cap the amount they spend on your health benefits for the year
  • No arbitrary cancellation of your policy. Your health insurance carrier can’t cancel your policy just because you get sick, and they can’t cancel you for making minor, unintentional mistakes on your insurance applications.
  • New, easier-to-understand summaries of what your insurance actually covers. All carriers are required to use the same standard format when outlining coverage so you can easily compare plans.
  • Coverage for adult children to the age of 26. Regardless of marital, job or student status, you can be kept on or added to your parent’s policy until you turn 26.
  • Insurance company accountability through the 80/20 Rule. The 80/20 Rule requires insurance companies to spend at least 80% of the money they make from premiums on health care instead of administrative costs, salaries, overhead and marketing. If an insurance company doesn’t meet the ratio, you will get a rebate from your premiums.

Except for grandfathered plans (click here for more information on grandfathering) new rights and protections also include:

  • Coverage for pre-existing conditions. Health plans can’t turn you down or charge more because you are or have been sick.
  • Additional insurance company accountability through rate reviews. Rate reviews will require insurance companies to publicly justify any rate increase of 10% or more.
  • Protection of doctor choice. You can choose any available primary care provider in your plan’s network for yourself and your kids. You do not need a referral from a primary care provider to see an obstetrician or a gynecologist.
  • Guaranteed emergency room care. Regardless of where you are, insurance plans can’t charge higher co-pays or co-insurance if you go to an emergency room that is out of your network. You also can’t be required to get prior approval for out-of-network emergency care.
  • Free preventive care. Health plans must offer screenings like colonoscopies, mammograms, blood pressure checks, and cholesterol tests at no cost.
  • Preventive care for women.  Health plans must cover the cost of a long list of preventive care for women, including breast cancer genetic testing, breastfeeding support, cervical cancer screening, contraception, STD screening, and osteoporosis testing. For a complete list, go to Preventive Care for Women at HealthCare.gov

The federal Health Insurance Marketplace website can answer all your questions about the Affordable Care Act. For comprehensive information, and to apply for insurance go to healthcare.gov.

Speak Your Mind

*