Pre-Existing Conditions:
Much of the healthcare reform legislation that recently passed is good news to those with pre-existing conditions who have had trouble affording health coverage in the past.
Effective immediately, insurers will no longer deny coverage to children with pre-existing conditions, whether the plan is old or new. Nothing in the new law stops them from raising premiums to cover the added costs now, but in 2014, insurers will not be able to raise premiums to cover those costs.
By late June 2010, a high-risk insurance pool will be created to allow those with preexisting conditions who have been uninsured for at least 6 months to obtain more affordable coverage in spite of their pre-existing conditions. In 2014, insurance companies will not be allow to deny anyone on the basis of pre-existing conditions or limit coverage based on health status, so this high risk pool is a temporary measure to allow uninsured people with pre-existing conditions to obtain more affordable coverage.
Medicare and Medicaid:
The new legislation will give some relief to retirees and those with Medicare who are paying out of pocket for their prescriptions. With the new legislation, Medicare patients who fall into the Part D “doughnut hole” will get a one-time $250 rebate, this year only. The doughnut hole, or Medicare Part D coverage gap , is the difference of the initial coverage limit and the catastrophic coverage threshold, as described in the Medicare Part D prescription drug program administered by the United States federal government. After a Medicare beneficiary surpasses the prescription drug coverage limit, the Medicare beneficiary is financially responsible for the entire cost of prescription drugs until the expense reaches the catastrophic coverage threshold. This rebate gives some of that money back.
Between November 15 and December 31 2010, people on Medicare can switch plans. If you have been covered under a private Medicare Advantage plan, carefully review your options for 2011. That’s when these plans start losing the extra subsidies they’ve enjoyed up until now, and some may respond by changing prices or benefits.
More changes to Medicare begin on January 1, 2011. All plans must start covering the full cost of proven preventive services, with no deductibles or copays, and provide a free annual “comprehensive health assessment”—a checkup, plus discussion of your personal risk factors and ways you might address them. And anyone who falls into the “doughnut hole” will receive a 50 percent discount on brand-name drugs. This subsidy will increase in subsequent years until the doughnut hole closes completely in 2020.
In 2013, Medicare taxes go up on adjusted gross incomes of more than $200,000 for individuals or $250,000 for couples. They’ll have to pay an extra 0.9 percent tax on all earnings above that threshold. And for the first time, these high earners will also have to pay a 3.8 percent assessment on unearned income such as stock dividends.
In 2014, all individuals under 65 with an income of less than 133 percent of the federal poverty level will automatically be enrolled in Medicaid, even if they don’t have dependent children.
Preventive Care:
It may be frustrating when you spend money treating conditions that you know could have been prevented, or doctors tell you ways to stay healthy and prevent illness but then your insurance slaps high co-payments or fees on you for procedures or check-ups that are preventive in nature. This will soon change. Starting in the next open enrollment period after September 23, 2010 (usually Jan 1 2011 for most employers) there will be no co-pays, co-insurance or deductibles on proven preventive care such as immunizations, mammograms and colonoscopies.
Requirements for Uninsured:
In 2014, all citizens and legal residents will be required to have health coverage. Those who decline to purchase coverage will be charged a tax penalty. Exemptions will be available for reasons of financial hardship and other reasons.
More Affordable Coverage:
One of the main goals of health reform is to make health coverage more affordable for all Americans, regardless of their income level. As a result of the newly passed legislation, In 2014, families and individuals who meet income requirements will receive subsidies in the form of refundable tax credits and reduced out-of-pocket costs in order to make required coverage more affordable.
Every state will have an exchange where individuals and small businesses (up to 100 employees) can purchase coverage. All plans sold on the exchange must offer unlimited annual and lifetime coverage, and must offer a comprehensive set of “essential benefits.”
Coverage for Adult Children:
Many college kids or recent grads have trouble with finding or paying for insurance. Starting in 2014, all health plans, new and old, must allow adult children to stay on their parent’s health plan until their 26th birthday, unless they have access to job coverage on their own.
Written by Kelly Matlock
