Got Health Insurance? What Health Reform Means
- No more lifetime maximums. In the past, people who hit their lifetime spending caps essentially became uninsured for the very illness for which they most needed coverage. Now, all health plans starting on or after Sept. 23 are prohibited from capping lifetime spending for necessary services like hospital stays. That’s a big deal for people being treated for serious illnesses, such as cancer, which can get very costly very fast.
- No more annual maximums. Limits on yearly spending for medical care will be restricted for new health plans in the private market (where people buy health insurance on their own) and all group health plans, including those that are grandfathered.
- ER costs limited. You don't need prior authorization for emergency care to be covered if you sign on to a plan starting on or after Sept. 23 (this doesn’t apply to grandfathered plans). And if you go to an ER out of your insurer’s network -- quite common in an emergency situation -- you can't be charged more than what you would have been charged by an in-network hospital.
- Direct access to OB/GYNs. Women with a new health insurance plan starting on or after Sept. 23 don't need a referral from their primary care doctor to see a gynecologist. This doesn’t apply to grandfathered health plans.
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.