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 https://www.pcip.gov/.
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 www.healthcare.gov.
Content adapted from healthcare.gov
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