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Health Care Reform:

Health Insurance & Affordable Care Act

How Health Reform Affects Arthritis Care Costs

Health care reform offers help for people with chronic conditions like rheumatoid arthritis or osteoarthritis. Under the law, you are guaranteed care for these conditions. You'll also find you can get medicine and pain treatment more easily. That means less worry about becoming disabled and losing your job. If you have a child with juvenile arthritis, you'll have less worry about keeping your child covered. Your child can stay on your insurance plan for much longer than in the past.

Arthritis Coverage

Under the Affordable Care Act, you can get or keep insurance coverage after you're diagnosed with arthritis. This is because:

  • You cannot be turned down for health insurance because of your arthritis.
  • You can buy an insurance policy just for your child, even if he or she has arthritis.
  • Your insurance cannot be canceled because you develop arthritis.
  • Your children must be covered by your insurance if you choose to include them on your policy. This is true even if a child already has arthritis.
  • Starting in 2014, you must be allowed to buy a health plan from any insurer even if you have arthritis.
  • All of your children can stay on your health plan until they reach age 26.

You'll also benefit from new rules that protect you from paying too much for your care or medicines. For instance:

You will not have a dollar limit on how much can be spent on your care. Annual and lifetime limits go away.

If you're sick, you can't be charged more for health insurance.

Your out-of-pocket costs will be limited. Health plans will have what is called a cap. Once you reach that amount, your insurance company covers the rest of your costs. That includes what you would spend on copays and deductibles for medical services and prescriptions.

Paying for Arthritis Medicine

Prescription drug coverage is one of 10 essential health benefits under the new law. That means it must be part of any policy that you buy through your state's health insurance Marketplace.

Soon you may also be able to choose generic versions of biologic arthritis drugs. Generics do not carry a brand name, but they are the same drug -- and they cost less. The Affordable Care Act gives the U.S. Food and Drug Administration the OK to approve generic biologics.

Managing Pain

You may benefit from other essential health benefits, too.  For instance, to care for your arthritis you may need:

If you're on Medicare, it includes the essential health benefits. So does Medicaid if you're new to Medicaid. Also, any plan you buy through your state's insurance Marketplace must offer these benefits. If you get insurance through your job, check your health plan to confirm the details of your coverage.

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