A Consumer’s Guide to the Health Care Reform Law
A Supreme Court decision is expected within the next two weeks on challenges to the 2010 federal health law. Parts of the law have already been implemented but the bulk of it won’t take effect until 2014.
Here’s a look at some of the key provisions of the law that apply to consumers and are already in place:
- Health plans can’t cancel coverage once you get sick — a practice known as “rescission” — unless you committed fraud when you applied for coverage.
- Children with pre-existing conditions cannot be denied coverage (this will apply to adults in 2014).
- Insurers will have to provide rebates to consumers if they spend less than 80 to 85 percent of premium dollars on medical care.
– If you are older than 65, the law is narrowing a gap in the Medicare Part D prescription drug plan known as the “doughnut hole.” That’s when seniors who have paid a certain initial amount in prescription costs have to pay for all of their drug costs until they spend a total of $4,700 for the year. Then the plan coverage begins again. That coverage gap will be closed entirely by 2020. Seniors will still be responsible for 25 percent of their prescription drug costs.
- The law also has expanded Medicare’s coverage of preventive services, such as screenings for colon, prostate and breast cancer, which are now free to beneficiaries. Medicare will also pay for an annual wellness visit to the doctor.
- If you are covered under a private Medicare Advantage plan, however, the law is cutting payments to some of those plans, and critics say that could mean the private plans may not offer many extra benefits that you may have previously enjoyed, such as free eyeglasses, hearing aids and gym memberships that they now provide.
These provisions are slated to take effect in 2014, if the law survives the high court’s review:
- Most people would be required to have health insurance starting in 2014 or pay a fine. That penalty for individuals would start at $95 or up to 1 percent of income and grow in later years. For families, it would start at $2,085 or 2.5 percent of household income.
- For low-income consumers, Medicaid, the state-federal program for the poor and disabled, would be expanded. If you have an income at or lower than 133 percent of the federal poverty level, which based on current poverty guidelines would be $14,856 for an individual or $30,656 for a family of four, you would be eligible.
- If you don’t qualify for Medicaid but still can’t afford insurance, you might be eligible for government subsidies. These premium subsidies will be available for individuals and families with incomes between 133 percent and 400 percent of the poverty level, or $14,856 to $44,680 for individuals and $30,656 to $92,200 for a family of four (based on current poverty guidelines). The subsidies would be used to help pay for private insurance sold in the state-based insurance marketplaces, called exchanges, slated to begin operation in 2014.
- Applicants cannot be rejected for insurance because of your health status once the exchanges are operating in 2014.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. Photo By Tom Williams/CQ Roll Call.