Changes to your health insurance coverage required by the Affordable Care Act have been phasing in for over two years now. Despite the complaints from a very vocal opposition, most of these provisions have proven to be very popular with the American public.
Key changes for individual health plans
2010
* Young adults can stay on their parent’s plan until they turn 26, or later if state law allows it.
* Lifetime dollar limits on key benefits like hospital stays no longer apply.
* For many plans, annual dollar limits on key benefits like hospital stays no longer apply.*
* Children younger than 19 can get coverage even if they had a disability or illness before signing up
for coverage. Some states have further defined the rules for children’s coverage.
* Certain preventive services like vaccines are covered 100% in network.*
* Health plans have new features the law called “patient protections.”*
* Members have more rights to appeal health plan decisions about health benefits and eligibility for
coverage.*
* A policy can be rescinded (canceled) only if the member intentionally misrepresents material facts
or is involved in fraud.
2011
* Members may be eligible for a rebate if their plan doesn’t spend at least 80% of premiums on
medical care and quality improvement during the year (some states have a different percent).
* Members get more access to information about rate changes that have been reviewed by the state
or federal government.
* Members who have a health savings account (HSA) can use HSA money for over-the-counter
medications only if they have a prescription.
* Members pay a higher tax rate if they use HSA money for unapproved items.
2012
* Benefit summaries will start to use a standard format that makes it easier to compare plans.
2014
* Regardless of health history, everyone will be eligible to apply for coverage. There may be required
“open enrollment” periods.
* There will be a requirement to have a minimum amount of health insurance coverage. Those who
don’t may have to pay a fine. There are some exceptions.
* People who don’t get health insurance at work will be able to shop for it through an exchange.
* All plans will cover certain key benefits. There won’t be an annual dollar limit on these benefits.
* New pricing rules take effect.
* Routine patient costs for clinical trials of life-threatening diseases will be covered.*
* This is not required for grandfathered individual health plans. In some cases companies have decided to apply a change in both grandfathered and non-grandfathered plans. According to the Department of Health and Human Services (HHS), this doesn’t cause a grandfathered plan to lose its grandfathered status.