Health Care Reform's 6 Month Anniversary

The Patient Protection and Affordable Care Act's 6 month anniversary, September 23rd, is coming up and there is no better way to celebrate than by outlining the series of new, monumental regulations to be imposed on insurance companies that day.

Will any of these benefit you? Share your story with PHAN today.

On September 23rd, the new health care law:

Ends pre-existing condition exclusions for children under 19. Thousands of American's kids are denied coverage by insurance companies every year. As of September 23rd, insurance companies will be prohibited from denying coverage to children based on a pre-existing condition. They also won't be able to institute benefit limitations.

Bans arbitrary rescissions of insurance policy. This horrid practice is when insurance companies retroactively cancel your policy when you become sick if you or your employer made an unintentional mistake on paperwork. So for example, they can - and do - refuse to cover chemo for someone recently diagnosed with cancer if this person didn't report having acne as a teenager. Under the new regulations insurers and plans will be prohibited from rescinding coverage - for individuals and groups of people - except in cases of fraud.

Gets rid of lifetime limits. A two million dollar policy may sound like a lot, but come down with an expensive chronic disease like M.S. and you'll find that 2 million won't last more than a couple years. After the lifetime limit is reached, the policy is revoked and meeting all future medical expenses is a responsibility that falls to you 100%. Many Americans have found themselves in bankruptcy or foreclosure after a similar situation. The new regulation prohibits the sue of lifetime limits in all health plans and insurance polices issue or renewed on or after September 23rd.

Restricts annual limits. Annual limits are less common than lifetime limits, but follow the same general idea. The Kaiser Family Foundation reports that 10 percent of cancer patients reached a limit of what insurance would pay for treatment and a quarter of families of cancer patients used up all or most of their savings on treatment. The new rules will phase out the use of annual dollar limits over the next three years until 2014 when the Affordable Care Act bans them for most plans.

Institutes a new appeals process. Plans issued on or after September 23rd must include streamlined guidelines for an internal appeals process. They must also include an external process for appeals, so that if the insurance company denies a claim the policy holder can take it to an external reviewer not employed by the insurance company. These regulations include provisions mandating there is an expedited process for emergency cases and that the insurance company picks up the lion's share of the cost for external reviews.

Allows youth up to the age of 26 to stay on their parent's plan. Youth will be able to be put onto their parent's plan as a dependent on open enrollment periods after September 23rd. The person needs to be under the age of 26, but doesn't need to be married, or filed as a dependent on tax statuses, or be a student. They only need to be the legal child of the parent looking to add them to their plan.

Mandates free preventive care. All plans offered on or after September 23rd must give policy holders free preventive care benefits including covering with no-cost sharing for all preventive services labeled A or B by the U.S. Preventive Services Tax Force. This includes annual check-ups, mammograms, colonoscopies, diabetes screening, depression screening, STD screenings, and other preventive care screenings and tests. It also includes vaccinations for children, autism screenings for children, hear and vision screenings and other additional screenings for children.

Creates small business tax credits. The first round of small business tax credits are available this year to qualifying businesses. Tax credits of up to 35% of premiums will be available to firms that chose to offer health care coverage. There is also up to 25% tax credits available to small non profits that offer health insurance.

Issues a rebate check to seniors in the 'donut hole.' This year seniors stuck in the donut hole in Medicare Part D will receive a $250 check to help with the costs. (Effective next year, the donut hole will begin to shrink every year until it is closed in 2020. Also, seniors will receive a 50% discount on brand name drugs.)

If any of these immediate changes will benefit you or your family or even if they would have benefited your family a year ago, we'd love to hear your story. Email me today at aford@pahealthaccess.org to share the good news!