Affordable Care Act

Top Things to Know about the Affordable Care Act

The following information is from www.healthcare.gov and www.hss.gov.

Families with Children

  1. Teens and Young Adults Can Stay on Your Plan: If your children are under age 26, you can generally insure them if your policy allows for dependent coverage.
  2. Coverage for Children's Pre-Existing Conditions: Job-based health plans and new individual plans are no longer allowed to deny or exclude coverage for your kids (under age 19) based on a pre-existing condition, including a disability.
  3. No More Lifetime Limits on Your Care: Insurance companies can no longer impose lifetime dollar limits on essential health benefits. And annual dollar limits will be phased out in 2014.
  4. Preventive Care Is Covered: Many insurers are now required to cover preventive services at no cost to you. This includes new preventive benefits for mothers and vaccinations for kids.
  5. Insurance Companies Are Held Accountable: Your premium dollars must be spent primarily on health care, not advertising or bonuses for executives. And insurance companies must now publicly justify any unreasonable rate hikes.

Individuals

  1. Under the health care law, insurance companies can no longer drop you when you get sick just because you made a mistake on your coverage application.
  2. Parents have new options to cover their children. If you have children under age 26, you can insure them if your policy allows for dependent coverage. The only exception is if you have an existing job-based plan, and your children can get their own job-based coverage.
  3. Job-based health plans and new individual plans are no longer allowed to deny or exclude coverage to any child under age 19 based on health conditions, including babies born with health problems.
  4. Starting in 2014, if your income is less than the equivalent of about $88,000 for a family of four today and your job doesn't offer affordable coverage, you may get tax credits to help pay for insurance.
  5. Starting in 2014, if your employer doesn't offer insurance, you will be able to buy insurance directly in the Health Insurance Marketplace that gives you power similar to what large businesses and members of Congress have to get better choices and lower prices.

People with Disabilities

  1. Under the health care law, job-based and new individual plans are no longer allowed to deny or exclude coverage to any child under age 19 based on a pre-existing condition, including a disability.
  2. Starting in 2014, these same plans won't be able to exclude anyone from coverage or charge a higher premium for a pre-existing condition including a disability.
  3. Insurance companies can no longer drop you when you get sick just because you made a mistake on your coverage application.
  4. Insurance companies can no longer impose lifetime dollar limits on your coverage.
  5. Medicaid covers many people with disabilities now, and in the future it will provide insurance to even more Americans.
  6. Starting in 2014, most adults under age 65 with incomes up to about $15,000 per year for single individual (higher income for couples/families with children) will qualify for Medicaid in every state. State Medicaid programs will also be able to offer additional services to help those who need long-term care at home and in the community.
  7. You may be able to join and get benefits from a voluntary, enrollment-based insurance program that will be available after October 2012 called the Community Living Assistance Services and Supports (CLASS) Program. On October 14, 2011, Secretary Sebelius transmitted a report and letter to Congress stating that the Department does not see a viable path forward for CLASS implementation at this time. View a copy of the CLASS report. Read about the original CLASS proposal.

Women

  1. Insurance Companies Can't Deny Coverage to Women. Before the Affordable Care Act became law, most insurance companies selling individual policies could deny coverage to women or charge them more due to pre-existing conditions, such as cancer and having been pregnant. Under the law, insurance companies are already banned from denying coverage to children because of a pre-existing condition. In 2014, it will be illegal for insurance companies to discriminate against anyone with a pre-existing condition.
  2. Women Have a Choice of Doctor. Thanks to the Affordable Care Act, all Americans joining new insurance plans have the freedom to choose from any primary care provider, OB-GYN, or pediatrician in their health plan's network, or emergency care outside of the plan's network, without a referral.
  3. Women Can Receive Preventive Care Without Copays. Beginning on August 1, 2012, about 1 in 3 women, or 47 million, under the age of 65 gained guaranteed access to additional preventive services, like mammograms and birth control, with no out-of-pocket costs. See a list of preventive services for women. (Preventive services benefits apply if you're in a new health plan that was created or changed substantially after March 23, 2010.) For example, if the healthcare law were not in place, the average out-of-pocket cost for a mammogram would be $39 and for birth control $78-$185 per year. Thanks to the Affordable Care Act, millions of women can access these services without cost sharing like copayments, co-insurance, and deductibles.
  4. Women Pay Lower Health Care Costs. Before the law, women could be charged more for individual insurance policies simply because of their gender. For example, a 22-year-old woman could be charged 150% the premium that a 22-year-old man paid. In 2014, insurers will no longer be able to charge women higher premiums than they charge men. The law takes strong action to control health care costs, including helping states crack down on excessive premium increases and making sure most of your premium dollars go for your health care.

Pregnant Women

  1. Job-based health plans and new individual plans are no longer allowed to deny or exclude coverage to your baby (or any child under age 19) based on health conditions, including babies born with health problems.
  2. New health plans must now cover certain preventive services without cost sharing.
  3. Starting in 2014, essential health benefits such as pregnancy and newborn care, along with vision and dental care for children, will be covered in all new individual, small business and Exchange plans.
  4. Starting in 2014, job-based health plans and new individual plans won't be allowed to deny or exclude anyone or charge more for a pre-existing condition, including pregnancy or a disability.
  5. In 2014, if your income is less than the equivalent of about $88,000 for a family of four today and your job doesn't offer affordable coverage, you may get tax credits to help pay for insurance.

Young Adults

  1. Under the Affordable Care Act, you can now be insured as a dependent on your parent's health insurance if you're under age 26. The only exception is if your parent has an existing job-based plan and you can get your own job-based coverage.
  2. New health plans must now cover certain preventive services without cost sharing.
  3. Starting in 2014, if you're unemployed with limited income up to about $15,000 per year for a single person (higher income for couples/families with children), you may be eligible for health coverage through Medicaid.
  4. Starting in 2014, if your employer doesn't offer insurance, you will be able to buy insurance directly in the new Health Insurance Marketplace. Individuals and small businesses can buy affordable and qualified health benefit plans in this new transparent and competitive insurance marketplace. Open enrollment begins on October 1, 2013.
  5. The Marketplace will offer you a choice of health plans that meet certain benefits and cost standards. Starting in 2014, members of Congress will be getting their health care insurance through the Marketplace, and you will be able buy your insurance through the Marketplace, too. Find out how you can get ready to enroll.
  6. Starting in 2014, if your income is less than the equivalent of about $43,000 for a single individual and your job doesn't offer affordable coverage, you may get tax credits to help pay for insurance.

Seniors

  1. Under the health care law, your existing guaranteed Medicare-covered benefits won't be reduced or taken away. Neither will your ability to choose your own doctor.
  2. Millions of people with Medicare received cost relief during the law's first year. If you had Medicare prescription drug coverage and had to pay for your drugs in the coverage gap known as the "donut hole," you received a one-time, tax free $250 rebate from Medicare to help pay for your prescriptions.
  3. If you have high prescription drug costs that put you in the donut hole, you now get a 50% discount on covered brand-name drugs while you're in the donut hole. Between today and 2020, you'll get continuous Medicare coverage for your prescription drugs. The donut hole will be closed completely by 2020.
  4. Medicare covers certain preventive services without charging you the Part B coinsurance or deductible. You will also be offered a free annual wellness exam.
  5. The life of the Medicare Trust Fund will be extended as a result of reducing waste, fraud and abuse, and slowing cost growth in Medicare, which will provide you with future cost savings on your premiums and coinsurance.

 

Bookmark and Share Last Updated: Wednesday, 26-Jun-2013 09:22:44 EDT
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