Changes in US Healthcare Regulations
AFFORDABLE CARE ACT
The Affordable Care Act was signed into law by President Obama on March 23, 2010, heralding in a number of changes that will go into effect over the next five years. Many of these changes have already occurred and are affecting the lives of millions of health insurance consumers in positive ways. The following is a synopsis of the health care changes affecting both insured and uninsured Americans of all ages.
CHANGES FOR PEOPLE WITH INSURANCE
Limits on Coverage will be Phased Out
On or after September 23, 2010 insurance companies can no longer put lifetime limits on the amount of coverage for essential benefits and the setting of annual limits for coverage will be restricted for all group and new individual plans. By 2014 annual coverage limits will be illegal.
Reducing Health Insurance Premiums
The new law will mandate that on or after January 1, 2011 at least 85% of insurance premiums collected by large employer plans on behalf of insurers will have to be spent on health care services and care quality improvements. The new limit for individual and small employer plans is 80%. If these thresholds aren’t met, the law requires the excess be returned to consumers through rebates.
On January 1, 2014, families earning between 43,000 and 88,000 dollars per year, in 2010 dollars, will receive additional tax credits for health insurance premiums and may be eligible for reduced copays, coinsurance, and deductibles.
Denial of Patient Claims will become more Transparent and Difficult
On or after September 23, 2010 all patients will be provided with a way to appeal any decisions made about their coverage by their insurance company, to their insurance company. What’s new is that the appeal process will be subjected to external review.
To provide further assistance to health insurance consumers, federal grants will be made available by October, 2010 to help establish local, independent patient/consumer advocacy agencies engaged in protecting patient’s rights, helping consumers navigate health coverage choices, and assisting the US Department of Health and Human Services to track difficulties encountered by health insurance consumers.
On or after September 23, 2010 insurance companies can no longer deny coverage to clients because of an error in the insurance agreements and claim applications.
By January 1, 2014 insurers will no longer be allowed to deny coverage or claims to individuals because they chose to participate in clinical trials.
“Donut Hole” Fix for Medicare
A gap in Medicare prescription drug coverage for an estimated 4 million seniors will be partially filled with a 250 dollar check mailed directly to covered seniors. The first checks were scheduled to arrive in mailboxes beginning in June, 2010. On January 1, 2011 seniors that fall within the donut hole will receive a 50% discount for brand-name prescription drugs covered under Medicare Part D. By 2020 the coverage gap will be closed.
Preventive Care
For health care plans beginning on or after September 23, 2010 insurers can no longer charge a deductable, co-pay, or coinsurance for essential preventive care like yearly physicals, colonoscopies, and mammograms. By January 1, 2011 these changes will also apply to seniors covered under Medicare. By January 1, 2013 Medicaid recipients will be able to obtain preventive care services for little or no cost.
Programs to help Americans improve and maintain their health will be supported financially with a 15 billion dollar Prevention and Public Health Fund that becomes available in 2010. These dollars are intended to help people quit smoking, lose weight, etc...
Increased Emphasis on Home Care
In an effort to reduce readmission rates for high-risk Medicare patients as they transition from hospital to their community, the Community Care Transitions Program will become active on January 1, 2011. Beginning on October 1, 2011 the Community First Choice Option will give states additional incentives to establish home and community-based services for disabled individuals receiving Medicaid.
CHANGES FOR THE UNINSURED
Individuals with a Pre-Existing Condition are now Covered
On or after July 1, 2010, individuals who have been without health insurance coverage for more than six months due to a pre-existing condition will be covered by either a state or national program.
On or after September 23, 2010, children under the age of 19 can no longer be denied coverage due to a pre-existing condition. This change in the law applies to new and existing group plans that began on or after this date.
Children not Eligible for Medicaid
On January 1, 2013 states will begin receiving an additional two years of funding to cover children not eligible for Medicaid.
Expanded Medicaid Coverage
Beginning April 1, 2010, states can receive matching federal funds up to 250 million dollars if they expand Medicaid coverage for low-income families and individuals. On January 1, 2014, low-income individuals making less than 14,000 dollars per year, in 2010 dollars, will qualify for Medicaid coverage.
Disabled adults who find themselves without long-term care insurance can apply for coverage under CLASS after October 1, 2012.
Employees without Health Insurance
Employees working for employers who don't offer health insurance coverage will be able to join an Exchange after January 1, 2014, and employees who can’t afford to buy into an employer health insurance plan will be able to take the money the employer would have otherwise contributed and purchase a more affordable policy through the new Exchanges.Prolonged Family Coverage for Young Adults
Beginning on September 23, 2010 young adults can choose to remain on their parent’s health care plan until the age of 26. The right to stay on their parent’s plan is voided should they be offered insurance coverage through an employer.
Stop-Gap for Early Retirees
Should an individual choose to retire early (55 to 65) they are often faced with high premiums when purchasing individual health insurance. To prevent the draining of valuable retirement savings by insurance premiums until they qualify for Medicare, the Affordable Care Act provides a program to assist employer plans to extend coverage through this period. Employer participation is voluntary, but starting June 1, 2010 they can apply to an established 5 billion dollar fund for financial assistance to set up this program in their company or institution. By 2014, this stop-gap will no longer be necessary because coverage for this demographic will be provided through the new Exchanges.
Reference: http://www.healthcare.gov/law/about/order/byyear.html