Many of the most popular consumer protection provisions of the massive health insurance overhaul President Barack Obama signed into law six months ago take effect today, though some people may not feel the impact until next year.

The new provisions include a ban on lifetime coverage limits, and free coverage for preventive care and immunizations. Young adults also will be able to stay on their parents' plans until they turn 26, and kids with pre-existing health conditions can't be denied coverage.

But as with just about everything surrounding the historic overhaul, implementing the reforms is not exactly as easy or automatic as throwing a switch.
People won't actually reap the benefits of many of those provisions until their next health insurance plan year begins, which could be Jan. 1 or as late as Sept. 1.

Allie Sethman is one of many in Delaware who stand to benefit from the new law -- just not quite yet. Sethman works at the University of Delaware and receives coverage through the state's plan with Blue Cross Blue Shield of Delaware. Her 22-year-old daughter Robin lost coverage under the family plan when she graduated from Wilmington University with a degree in business administration this past May.
Robin has been working part-time since, but can't afford to buy individual coverage, so she has gone without. "I'm kind of out of options," Robin Sethman said.

Under the new law, she'll be able to re-enroll on her mom's health plan, but not until July 1, the beginning of the state health program's next plan year.
"It's upsetting to know your child does not have health insurance," said Allie Sethman, who lives with her family in Middletown. "The goal is to get more people on health insurance. They're defeating the goal by waiting until next year."

Many of the health reform law's most significant provisions don't go into effect until 2014. For example, the requirement that everyone carry insurance so that no one can be denied insurance is still four years away.

Misinformation lives on
But many people remain confused about the complex provisions.

A new Associated Press poll found more than half of Americans mistakenly believe that they'll pay more in taxes this year to fund health reforms.

A July poll from the nonpartisan Kaiser Family Foundation found that more than a third of American senior citizens wrongly believe the bill created "death-panels," government groups empowered to make end-of-life care decisions for Medicare patients.

The simpler parts of the bill were set to be introduced today, six months after the bill was signed. Provisions rolling out include the ban on caps on the dollar amount of claims over a lifetime. Restrictions on annual benefit payouts must disappear in 2014.

Also starting with policies taking effect today, insurers are no longer allowed to drop someone's coverage when he gets sick because he made an unintentional error on the application, according to the U.S. Department of Health and Human Services, which is overseeing implementation of the health reforms.

Insurers also can't deny coverage for children because of pre-existing medical conditions. A similar provision for adults does not go into effect until 2014, although states already have established "high-risk" coverage pools for adults who can't get coverage because they have an illness.

Health insurers must establish processes for appealing claims decisions that include a procedure for internal review and a system allowing consumers to appeal a claim rejection to an outside party. Insurers also must provide coverage, without cost-sharing like a co-pay, for preventive services such as recommended immunizations, mammograms and colonoscopies.

The provisions that take effect today apply to policies people buy themselves directly from an insurance company like Aetna or Coventry, and to large plans offered by employers. But even that aspect has a caveat.

Health plans that predate the reform bill may be "grandfathered out" of some of its provisions, such as the mandatory preventive care coverage and the restrictions on coverage caps, if they remain essentially unchanged, which few do year to year.

Those plans lose their exemption if they change significantly -- if co-pays are raised above certain limits, for example, or if coverage is eliminated for some conditions.

Jennifer Tolbert, an expert in health policy at the Kaiser Family Foundation, said the grandfather provisions were intended to limit "upheaval in the market" while also providing "new and important protections."

The new consumer protections that take effect today join others already in effect.

Filling the doughnut hole

The federal government, for example, has launched the high-risk insurance pools for people with pre-existing conditions. And seniors on Medicare who reached the so-called "doughnut hole" in prescription drug coverage have already received $250 rebate checks.

That rebate was a big deal for Helen Gunter, 67, of Marydel, who said she would not have been able to cover a $378 bill for her three-month supply of breast cancer medicine because she had reached the Medicare drug-benefit gap that requires beneficiaries to pay the full bill.

"I didn't have the money to get it filled," said Gunter, a widow who lives on less than $1,900 a month.

Gunter joined Obama and others at a home in Falls Church, Va., on Wednesday afternoon as part of an administration push to build support for health reforms, which many Americans still view with skepticism. Some 45 percent of Americans hold an overall unfavorable view of the reform law, according to an August Kaiser poll. Three in ten support a full repeal.

Linda Blumberg, a health policy expert at the liberal Urban Institute, said the protections taking effect today are important, particularly for ill Americans running up against coverage limits, or those who have been dropped by their health plans. But Blumberg cautioned that they won't be as broadly felt as provisions that take effect in 2014, such as the "individual mandate" that everyone carry insurance.

"I think that these are pieces that are going to impact certain people very significantly," Blumberg said. "They are provisions that are very popular and I think people are going to appreciate them. But they are interim types of reforms. These are not comprehensive reforms that are going to make people completely comfortable that they have secure, affordable health insurance."