Now that the Supreme Court has decided that the Affordable Care Act can stand, it’s time to think about what the law actually means for your medical coverage. The requirement that everyone buy health insurance (the individual mandate) has gotten all the attention, but there’s a lot more to the health law. So let’s review the changes the law has already wrought and those that still lie ahead:
WHAT’S IN EFFECT:
- Health insurance providers can’t cancel your coverage once you get sick – a practice known as “rescission” – unless you committed fraud or intentionally withheld facts about your health when you applied for coverage.
- Youth can be covered under a parent’s plan until they turn 26.
- Children with pre-existing conditions cannot be denied coverage.
- Health insurance providers may not place a lifetime maximum on benefits.
- Insurers are required to give consumers rebates if they spend less than 80 to 85 percent of premium dollars on medical care. Insurers are required to issue this first round of rebates by Aug. 1.
Health plans created after Sept. 23, 2010, are required to cover certain preventative services without requiring copays, deductibles and coinsurance.
The law also expands Medicare’s coverage of preventive services, such as screenings for colon, prostate and breast cancer, which are now free to beneficiaries. Medicare will also pay for an annual wellness visit to the doctor.
- If you are covered under a private Medicare Advantage plan, the law changes portions of the plan, cutting payments to some of those plans. Critics say that could mean the private plans may not offer many extra benefits that you may have previously enjoyed, such as free eyeglasses, hearing aids and gym memberships that they now provide.
- If you are older than 65, the law is narrowing a gap in the Medicare Part D prescription drug plan known as the “doughnut hole.” That gap applies to seniors who have paid a certain initial amount in prescription drug costs and must then pay the full cost until they spend a total of $4,700 for the year. Then the plan coverage begins again. By 2020, the “doughnut hole” will be closed entirely.
- Starting Aug. 1, employers must provide health insurance plans that offer birth control as part of their preventative services.
WHAT’S COMING IN 2014:
- Adults with pre-existing conditions will not be denied coverage (this already applies to children).
- Most people will be required to have health insurance starting in 2014 or pay a fine. That penalty for individuals starts at $95 or up to 1 percent of income and grow in later years. For families it would start at $2,085 or 2.5 percent of household income. The Supreme Court noted in its decision that Americans could choose to ignore the mandate and instead pay the penalty, which they deemed a tax.
- People who don’t qualify for Medicaid but still can’t afford insurance may be eligible for government subsidies. The subsidies would be used to help pay for private insurance sold in the state-based insurance marketplaces, called exchanges, slated to begin operation in 2014.
- Applicants will not be rejected for insurance because of health status once the exchanges are operating in 2014.
WHAT’S CHANGING AFTER TODAY’S RULING:
- The Supreme Court ruled that Congress has the authority to expand Medicaid, but it can’t strip states of all their Medicaid funds if they fail to participate in that expansion. Prior to the court’s decision, analysts expected that about half of the people who would gain insurance under the law would do so through Medicaid. Under the Supreme Court’s ruling, it’s up to each state to decide whether it expands coverage to more people.
Mary Agnes Carey reports for Kaiser Health News.