Today marks the six-month anniversary of enactment of the health reform law, and with it, a slew of consumer-friendly provisions go into effect.
Kaiser Health News: Among the new rules, "[a] provision of the new health care law that bars insurers from denying coverage of children up to 19 with preexisting medical conditions takes effect." There could be problems, however, as some insurers are dropping kids-only plans entirely and such insurance may be cost-prohibitive for many. "For years, insurers — principally those in the individual insurance market — have denied coverage to children, as well as adults, with medical conditions. In some cases, they have accepted them but refused to cover their preexisting conditions for a set period. Now, such practices are banned for children, and will be prohibited for adults in 2014. The Department of Health and Human Services, which is writing the regulations implementing the law, estimates that 31,000 to 72,000 uninsured children with preexisting conditions will gain coverage due to the provision between now and 2013. And 90,000 insured children will get coverage for preexisting conditions that have been excluded from coverage, the department estimates" (McGinley and Carey, 9/23).
In a separate story, Kaiser Health News has a video and a transcript featuring health reporter Michelle Andrews, who explains how the health law could affect you (9/23).
Time has a list of the new health rules starting today and what they will (and won't) do. "Regulations that kick in today also allow people more freedom to choose doctors within their insurers' networks and freedom to receive covered care in emergency rooms even if they are not pre-approved. Insurers also must follow a strict set of guidelines when handling claim appeals" (Pickert, 9/23).
The New York Times: "Insurers also will be prohibited from imposing lifetime limits on benefits. The law will now forbid insurers to drop sick and costly customers after discovering technical mistakes on applications. It requires that they offer coverage to children under 26 on their parents' policies. It establishes a menu of preventive procedures, like colonoscopies, mammograms and immunizations, that must be covered without co-payments. And it allows consumers who join a new plan to keep their own doctors and to appeal insurance company reimbursement decisions to a third party." The provisions, not accidentally, go into effect right before Democrats start their push to keep control of Congress in November's midterm elections (Sack, 9/22).
The Associated Press: The health law will allow people to get preventive health care without copays. "The list includes tests strongly recommended by the U.S. Preventive Services Task Force, an independent advisory panel that evaluates research." It has a list of preventive services that will be available for free to everyone with insurance in America (Johnson, 9/22).
NPR, on the practice of rescission, which will be mostly outlawed in health plans: "At a congressional hearing last year ... the CEOs of several insurance firms said they had basically no choice but to rescind some policies, at least until everyone is required to have health insurance." Insurers fear that people will wait until they are sick to buy policies. The health law also includes a provision that nearly everyone in America carry health insurance starting in 2014 (Rovner, 9/23).
For Some, Benefits Won't Kick In Right Away
The Atlanta Journal Constitution: "The changes imposed by the Patent Protection and Affordable Care Act, enacted March 23, won't be immediate for most consumers. The changes won't take effect until a consumer buys a new policy or renews an existing one. And insurers can avoid some of the requirements, such as the free preventive services, if they make no significant changes to their current plan" (Teegardin, 9/23).
Chicago Tribune: "[P]rovisions in the law allow employers to delay implementation until next year, particularly if the company is self-insured. In that case, benefits will start Jan. 1 when most health plan renewals begin. But they could start as late as spring, depending on the new benefit year for the employer. Health benefits experts and large employers say consumers with coverage should pay particular attention this month when the fall ritual known as open enrollment begins. This time period, which often runs through November, allows workers with coverage to sign up for health benefits or change to a different plan offered by the company."
PBS Newshour's 'Rundown' Blog: "Some of the changes will not apply to "grandfathered" plans — plans that existed before the law was signed on March 23 and that haven't made significant changes since then. This is particularly true for individual insurance plans. For both group and individual grandfathered plans, the changes providing free access to preventive care and expanded access to ob-gyn's and emergency care will not apply. Individual plans that are grandfathered do not have to accept children regardless of pre-existing conditions, and also do not have to comply with the new $750,000 minimum for annual limits. Even if your plan is a grandfathered one, however, there's a good chance it won't stay that way long. That's because in order to keep the status, the plans cannot make any significant changes, such as raising premiums, co-pays or deductibles" (Winerman, 9/22).
What It Means For You
In the meantime, U.S. News & World Report has a list of four ways to prepare for the changes, including looking for letters about how your specific coverage will change from your insurer, reading the fine print on preventive care services, watching out for rising premiums and not assuming it's cheaper to add a grown child to your plan (Kotz, 9/22).
The Associated Press, in a separate story, showcases three families that will benefit from the new provisions, including Bob and Michelle Cunningham, who couldn't get their son insurance in the past because he is a cancer survivor with a "pre-existing condition." "Under the new health care law, the family will be able to buy insurance covering their son. That means Bob Cunningham can pursue his small business dream, instead of plugging away at a discouraging search for employment that provides health benefits" (Johnson, 9/23).
Finally, Kaiser Health News has a guide to Sept. 23, stories about what the changes mean to different people and provides links to groups that go into greater detail about the changes.