Monday, August 27, 2012

What Does Healthcare Reform Mean for YOU



Now that the Supreme Court has upheld much of the constitutionality of the Patient Protection and Affordable Care Act signed into law by President Obama in 2010, it is the perfect time to review many of the key provisions that could affect you!

The changes that have already taken place are:

o   Children under 19 are not able to be denied coverage due to a preexisting condition.

o   Adult children are now able to remain on their parent’s medical plan until the age of 26.

o   Lifetime maximum payouts for insurance plans were eliminated.  In addition, the annual coverage limits are going to be phased out.  Beginning on September 23, 2012 the annual limit will be increased to $2 million.

o   All new plans are now required to provide certain preventative services free of charges.  Some examples include mammograms, immunizations and colonoscopies.

o   Those who may have been refused coverage in the past due to a preexisting condition may now be eligible for coverage through their state’s “high-risk pool” program.  To learn more about this program, you can visit

o   Those who are eligible for and participate in Medicare Part D and who reach their “doughnut hole” will now be eligible to receive a 50% discount on brand-name prescription drugs and a 14% discount on generic medications.  These discounts will continue to increase until 2020 when the doughnut hole will disappear.

The highlights of what you can expect between now and 2014:

o   August 1, 2012 – insurance companies that did not spend at least 85% of the 2011 premium dollars (for any large group plans with more than 50 employees) on medical care will be required to refund the difference through refund check or by discounting future premiums. 

o   October 1, 2012 – all plans must begin to adopt rules for the safe and secure electronic exchange of health information to reduce paperwork, cost and medical errors.

o   January 1, 2013 – a new federal ruling will be in place for state Medicaid programs that choose to cover preventative services to their members at little or no cost to them.

o   October 1, 2013 – States will receive two years of additional funding to continue coverage for children that are not eligible for Medicaid.

o   January 1, 2014 – Most key provisions of the PPACA will be in place, including:

-          Those individuals whose employers do not offer them health coverage will be able to purchase state-based coverage through Affordable Insurance exchanges.  These exchanges will offer a number of different health plans that are required to cover certain services and follow mandated standards.

-          Many of those who are able to afford health coverage but choose not to obtain it will be required to purchase coverage or pay a fee to offset the cost for the uninsured Americans.  Those Americans who earn less than 133% of the poverty level will eligible to enroll in Medicaid.

-          Tax credits will become available to those who earn between 100% and 400% of the poverty level to help them pay for affordable insurance options.  They may also qualify for other savings including reduced co-payments, coinsurance and deductible amounts.

-          Limitations on annual coverage dollars will be eliminated

-          Adults can no longer be refused coverage because of preexisting conditions.

-          Insurance companies will be prohibited from charging higher rates to individuals and small groups based on gender or health status. 

-           To learn more about the upcoming healthcare reform changes that could affect you, check our blog and visit


Content adapted from