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Health Care Reform:

Health Insurance & Affordable Care Act

Got Health Insurance? What Health Reform Means

If you have health insurance (including Medicare or Medicaid) now, health reform will still affect you. Here's how.

Everyone continued...

Coming in January 2014:

  • New coverage options. Health insurance exchanges will provide a marketplace where small businesses and people who don’t get health insurance through their employer can shop for plans. The exchanges will offer the full range of private and public health insurance options available to them in their state.
  • Help paying for coverage. For people making $43,000 or less, or families of four making less than $88,000, the government will subsidize premiums -- the monthly payment you make to insurers for coverage -- for health plans purchased through health insurance exchanges. You’ll pay anywhere from 2% to 9.5% of your income for health insurance, and the government will pick up the rest. Reduced copayments, coinsurance, and deductibles may also apply to assist with coverage cost. Also, the new law states that the cost of premiums can be no more than three times as expensive for older people than for younger people.

 

Young Adults and Children

Starting Sept. 23, 2010:

  • Children with pre-existing conditions can’t be denied. Insurers can no longer deny care related to a pre-existing health condition for children younger than 19. This applies to new and grandfathered plans in the group market (the insurance you get from your employer). But it doesn't apply to people who have existing plans they bought on their own in the individual market.
  • Parental coverage until 26. Adult children who don’t have insurance through a job of their own can stay on their parents’ health plan until age 26. Some employers offered this benefit as soon as health reform became law; others lagged. Although employers typically hold open enrollment for health care plans in the fall, those choices take effect in January. That leaves a couple of months before your young adult is covered. "We're seeing a lot of kids now who are in that window," says Carrie McLean, consumer specialist with eHealthInsurance.com.

 

Retirees and Seniors

Already in effect:

  • Rebates to close the “donut hole." Starting in June, the government began mailing $250 checks to Medicare recipients who hit the “donut hole,” or the gap in coverage for prescription medications.

The government expects about 4 million people to hit the donut hole in 2010. According to Ross Blair, CEO of Plan Prescriber, a site that helps people on Medicare compare Medicare Advantage plans (Medicare coverage administered by a private insurer), this gap in coverage exposes many seniors to thousands of dollars out of pocket each year.

Checks will continue to be sent throughout 2010. You don’t have to apply. The government tracks prescriptions filled and will automatically mail a check, which typically arrives four to six weeks after reaching the gap in coverage.

  • Early retiree coverage. People who retire and give up employer-sponsored health insurance before they're old enough for Medicare are often left without affordable health plan options. Until the health exchanges launch in 2014, businesses willing to extend coverage to workers (and their dependents) who retire between the ages of 55 and 65 will be reimbursed by the government to offset the cost of doing so.

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