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Health Care Reform:

Health Insurance & Affordable Care Act

Health Reform Law Timeline

2010 Changes continued...

Impact: Nearly 5 million children diagnosed with illnesses that can be considered pre-existing medical conditions and result in a denial of insurance coverage are protected by this provision of the law.

Provision: Preventive Care With No Co-pay

Effective: Sept. 23, 2010

All new health plans are required by law to pay for a range of preventive medical services. These include diabetes and high blood pressure screenings, cancer screenings (such as colonoscopies and mammograms), vaccines, and well baby and child visits. No co-payments or deductibles are required at the time of care. This does not apply to insurance plans with grandfathered status.

Impact: The Department of Health and Human Services estimated that to date, 54 million Americans have received preventive benefits without cost-sharing as a result of this provision of the ACA.

Provision: No More Lifetime Limits

Effective: Sept. 23, 2010

Both individual and group health plans renewing on or after Sept. 23, 2010, can no longer place a lifetime dollar limit on most medical benefits. Prior to the law’s enactment, 50% of people with employer insurance and 89% of people who purchased coverage on their own had a lifetime limit on benefits. 

Impact: The Department of Health and Human Services estimates that 105 million Americans now have expanded insurance coverage as a result of this provision.

2011 Changes

Provision: Drug Discounts for People on Medicare

Effective: Jan. 1, 2011

Seniors who reach the “doughnut hole” or gap in Medicare Part D prescription drug coverage receive a 50% discount on covered brand-name drugs, as well as a discount on generics (7% in 2011, 14% in 2012). Seniors will pay an increasingly smaller portion of their drug costs until the coverage gap closes entirely in 2020.

Impact: More than 5.35 million seniors enrolled in part D drug plans saved $3.7 billion between March 2010 and December 2011.

Provision: Ensuring That Insurance Premiums Go to Health Care  

Effective: Jan. 1, 2011

Insurers are required to spend 85% of all premiums they collect on health care services for large employer plans, as opposed to administrative costs or profits, and at least 80% for individual and small employer health plans. Insurance companies that fail to meet minimum spending requirements will be required to give rebates to their customers. Rebates are scheduled to begin later this year.

Impact: In August 2012, 12.8 million Americans are expected to receive rebates worth $1.1 billion.

Provision: Free Preventive Care for Seniors

Effective: Jan. 1, 2011

Seniors with Medicare coverage no longer pay annual deductibles, co-pays, or coinsurance for preventive medical services such as annual wellness visits, or heart disease and cancer screenings such as mammographies and colonoscopies.

Impact: Thirty-two million Medicare recipients have received free preventive services under the new law.

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