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How Will Health Reform Affect Me?

Immediate Benefits of Health Reform Legislation

By

Updated April 02, 2010

How Will Health Reform Affect Me?

Health Reform - How Will It Affect Me?

mstahlphoto@iStockphoto

Virtually all Americans will be affected in some way with the enactment of the Patient Protection and Affordable Care Act, which President Obama signed into law on March 23, 2010. How you are impacted personally depends on how the fine details of the legislation are implemented.

Your age, employment status, income, current insurance coverage, and health status can all influence how the health reform legislation may have an effect on you and your family.

The actual bill signed into law fills more than 1,000 pages and details a set of immediate health insurance benefits along with a plan for rolling out additional benefits over a four-year period and beyond.

The following benefits will be available within the first year after the bill’s passage:

Small Business Tax Credits
Effective immediately, this provision offers tax credits to small businesses to make health coverage for employees more affordable. Initially, a tax credit of up to 35% of the cost of health insurance premiums will be available to eligible employers that choose to offer coverage. Eligibility for the tax credits depends on the number of employees and the average salaries.

No Pre-existing Coverage Exclusions for Children
Effective six months after enactment, this provision prohibits your health plan from excluding coverage of pre-existing conditions for children. Starting in 2014, this provision will apply to adults as well.

Access to Health Coverage for the Uninsured with Pre-existing Conditions
Effective 90 days after enactment, this provides federal funding for a new program that offers affordable coverage to uninsured Americans with pre-existing conditions until the new Health Insurance Exchanges are functioning in 2014.

Free Prevention Benefits
Effective six months after enactment, this provision requires that all new health plans offer prevention and wellness benefits. Additionally, it eliminates out-of-pocket expenses (such as deductibles and copayments) for these services in all public and private insurance plans.

Closes the Coverage Gap in the Medicare (Part D) Drug Benefit
Effective immediately, this provides a $250 rebate check for any Medicare beneficiary who hits the donut hole in 2010. In 2011 seniors in the donut hole can get a 50% discount on brand-name drugs. By 2020 the donut hole will be filled.

Free Prevention and Wellness Visits in Medicare
If you are enrolled in Medicare, you only are covered for an initial physical exam. Effective in 2011, people with Medicare will receive a free, annual wellness visit and will have all out-of-pocket expenses waived for preventive care.

Extension of Coverage for Young Adults
Effective six months after enactment, this provision requires your health plan to allow your children to stay on your family policy until age 26 – unless your young adult is eligible for employer health coverage.

No Lifetime Limits on Coverage
Effective six months after enactment, this provision forbids your health insurer from imposing any lifetime limits on your benefits.

Protection from Rescissions of Existing Coverage
Effective six months after enactment, this provision stops your health plan from cancelling your insurance when you file a claim, except if you have committed fraud or you intentionally misrepresentation the facts about your health.

Choose Your Own Healthcare Provider
Effective six months after enactment, this provision protects your choice of doctors by allowing you to pick any participating primary care provider and prohibits your health plan from requiring prior authorization before you can see an ob-gyn physician.

Increasing the Number of Primary Care Providers
Effective during 2010, new federal funds will be made available for training programs to increase the number of available primary care doctors, nurses, and public health professionals. With more Americans having health insurance, there is a great need for additional primary care providers.

Expand Community Health Centers
Effective during 2010, the federal government will invest $11 billion over five years to expand Community Health Centers. This should improve access to primary care services in communities where it is needed most.

Ensuring Value for the Premiums You Pay
Effective in 2011, this provision establishes standards for how health plans use the premiums they collect and requires that this information be made public. Depending on the type of health plan, your insurer will be required to spend 80% to 85% of the premium dollars it collects to pay for health-related services and activities to assure that you are getting quality care.

Access to Information on Your Insurance Options
Effective in 2010, this provision calls for the creation of a new website to provide information about your health plan options. This should facilitate your ability to make an informed decision about the coverage you need.

Consumer Health Insurance Assistance Programs
Effective in 2010, this provision offers support to help states establish health insurance consumer assistance or health insurance ombudsman programs. If implemented in your state, this program could help you deal with health plan related issues such as filing a complaint, appealing a decision, enrollment problems, and, in time, assist you with resolving problems with tax credit eligibility.

Better Appeals Process
Effective six months after enactment, this provision requires all new health plans to put into practice a more helpful process for appeals of coverage determinations and claim denials. And, your state will provide an external appeals process to make sure that you are able to have an independent review.

The “Devil Is in the Details”

Although these immediate health reform benefits will most likely have some effect on you, it is not clear what the costs will be overtime. Many questions remain and it will take months, if not years, for the country to fully understand the impact of reform on our health care system.
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