Healthcare Reform: How Will It Affect you?

By Jamilla Williams
Director of Case Managers,
Patient Advocate Foundation

After years of debate, Congress passed the Patient Protection and Affordable Care Act (PPACA), which was signed into law on March 23, 2010, by President Barack Obama. This new healthcare reform law is estimated to provide coverage to more than 30 million Americans who currently lack health insurance. But how will that really play out? Here are some answers to a few common questions about the new law.

What are the immediate benefits of PPACA in 2010/2011?

It provides a $250 rebate check for Medicare Part D enrollees who hit the “donut hole.” Effective calendar year 2010.

It allocates $5 billion to establish the Pre-Existing Condition Insurance Plan (PCIP) for uninsured individuals with a pre-existing condition. Effective July 1, 2010.

It eliminates pre-existing-condition exclusions for children under 19. Effective for policy or plan years beginning on or after September 23, 2010; applies to all employer plans and new plans in the individual market.

It prohibits rescissions by health insurance companies. Effective for policy or plan years beginning on or after September 23, 2010; applies to all plans.

It prohibits insurers from imposing lifetime limits on benefits. Effective for policy or plan years beginning on or after September 23, 2010; applies to all plans.

It tightly restricts plans’ use of annual limits. Effective for policy or plan years beginning on or after September 23, 2010; applies to new plans in the individual market and all employer plans.

It provides grants to states for establishing health insurance consumer assistance or ombudsman programs to assist individuals with the filing of complaints and appeals and the enrollment in a health plan. Grant applications due September 10, 2010.

It requires coverage of prevention and wellness benefits in all new plans and exempts these benefits from deductibles and other cost-sharing requirements. Effective for policy or plan years beginning on or after September 23, 2010; applies to all new plans.

It extends dependent coverage until age 26. Effective for policy or plan years beginning on or after September 23, 2010; applies to all plans in the individual market, new employer plans, and existing employer plans.

It requires all new health plans to implement an effective process for appeals of coverage determinations and claims. Effective for policy or plan years beginning on or after September 23, 2010; applies to all new plans.

It provides Medicare beneficiaries with a free, annual wellness visit. Effective January 1, 2011.

It provides Medicare beneficiaries with a 50 percent discount on brand-name drugs and biologics when they reach the donut hole. Effective January 1, 2011.

What is the Pre-Existing Condition Insurance Plan?

The Pre-Existing Condition Insurance Plan was created to make health insurance available to individuals who have had a problem accessing health insurance due to a pre-existing condition. States were given the option to administer the PCIP themselves or to have the federal government administer it for them. The PCIP will cover a wide range of health benefits, including primary and specialty care, hospital care, and prescription drugs. The plan will not charge a higher premium based on an individual’s medical condition and does not base eligibility on income. Enrollees are required to be a citizen of the United States or lawfully present in the United States, must have been uninsured for the six months prior to applying, and must have had a problem obtaining insurance due to a pre-existing condition. Information and applications for the PCIP can be accessed at www.pcip.gov.

What additional benefits will the new healthcare law provide in the future?

The PPACA includes the following provisions that will benefit patients in the near future:

Businesses with fewer than 50 employees will receive tax credits covering up to 50 percent of employee premiums.

Community health centers will receive an additional $11 billion in funding to expand.

Effective January 1, 2011, health plans in the individual and small-group markets will be required to spend 80 percent of premium dollars on clinical services and quality activities; plans in the large group market will be required to spend 85 percent.

Effective January 1, 2014, all insurance companies will be prohibited from denying coverage based on pre-existing conditions.

The PPACA will eliminate financial and healthcare access burdens faced by many patients, including those with serious diagnoses such as cancer. To learn more about the health reform law and understand how it will affect you, visit www.healthcare.gov.

Patient Advocate Foundation provides direct case management services free of charge to patients diagnosed with a chronic, life-threatening, or debilitating illness. The case management staff is qualified to provide information and answer questions regarding healthcare access issues and how healthcare reform may affect you. Case managers are available Monday through Friday, 8 a.m. to 8 p.m. eastern standard time. For further information please contact Patient Advocate Foundation at (800) 532-5274 or www.patientadvocate.org. In addition, National Patient Advocate Foundation provides the patient voice in improving access to, and reimbursement for, high-quality healthcare through regulatory and legislative reform at the state and federal levels. Patients can access the website at www.npaf.org to learn about current healthcare reform law and to join NPAF Patients Advocate Network.

Sources

1.Health Care Reform: Overview. New York Times website. Available at: http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/health_insurance_and_managed_care/health_care_reform/index.html.
2.Timeline: What’s Changing and When. HealthCare.gov website. Available at: http://www.healthcare.gov/law/timeline/index.html.
3.Timeline: When Health Care Reform Will Affect You. CNN.com. Available at: http://www.cnn.com/2010/POLITICS/03/23/health.care.timeline/index.html.