Health insurance changes today; your plan — maybe not

The nation’s new health care law turns 6 months old today and starts delivering protections and dollars-and-cents benefits that Americans can grasp. But it won’t affect all consumers the same way, which may cause confusion.

Q: Will everyone’s health insurance change today?

A: No. It depends on when your health insurance plan year starts. Many of the new requirements begin with plan years starting on or after Sept. 23. But if your plan year starts Jan. 1, as many do, that’s when the changes start.”Grandfathered” plans, those that existed before the law was enacted March 23 and which remain essentially unchanged, must meet only some of the requirements. New plans and those with significant changes in benefits or out-of-pocket costs must comply with even more changes in the law.

Q: How do I know how my health plan fits in all this?

A: If you get insurance through work, ask your employer about any changes. If you buy insurance yourself, call your insurance company.

Q: What are some of the new benefits?

A: Free preventive care, for one. Some people will no longer have to pay co-pays, co-insurance or meet their deductibles for preventive care that’s backed up by the best scientific evidence. That includes flu vaccines, mammograms and even diet counseling for adults at-risk of chronic disease.

Q: Are there exceptions?

A: Free preventive care isn’t required of existing health plans that haven’t changed significantly, those “grandfathered” plans we mentioned earlier. New plans, and those that change substantially on or after Sept. 23, must provide this benefit.

Q: What other changes start Sept. 23?

A: If you go to an emergency room outside your plan’s network, you won’t get charged extra. Patients will be able to designate a pediatrician or an ob-gyn as their primary care doctor, avoiding the need for referrals that are required by some plans.

Q: I’ve heard lifetime limits are being eliminated. What does that mean?

A: Millions of Americans have insurance that sets a cap on what their insurance will pay to cover their medical costs over a lifetime. The caps have left very sick patients with medical bills topping $1 million or $2 million high and dry. These lifetime limits will be eliminated for plans issued or renewed on or after Sept. 23.Those who have maxed out because of the caps but remain eligible for coverage must be reinstated on the first day of the plan year that begins on or after Sept. 23.

Q: What about annual limits?

A: Plans issued or renewed on or after Sept. 23 can’t have annual limits lower than $750,000. Annual limits will be eliminated entirely by 2014.

Q: Are there exceptions?

A: Employers and insurance companies can apply for waivers for so-called “mini-med” plans that offer limited benefits. The intent of the waivers is to allow these low-cost plans to exist so that people don’t lose their health coverage when premiums go up.

Comments (3)

  1. Submitted by T J Simplot on 09/23/2010 - 11:41 am.

    Just one thought:

    1. It should not be referred to as “free” preventive care. It may be free to the member but it is not free to the insurance company. Instead, it should be billed as “100% coverage for preventive care”.

    One of the dangers of calling something “free” is that it removes any inclinations that there may be any cost involved whatsoever, even by another party.

  2. Submitted by Glenn Mesaros on 09/23/2010 - 02:28 pm.

    Anthem Blue Cross, Aetna, United Health, Cigna and others have decided to stop selling child-only policies for children under 19 with pre-existing conditions who are not already covered under a child-only policy, or a family policy. Aetna will discontinue coverage of this group in 32 states; Anthem in 10, and Cigna in 10 states. So, Obamacare’s dictum that children under 19 with pre-existing conditions must have insurance has been rejected by the insurance companies.

    In California, whose economy would be the 6th largest in the world were it a nation, 80,000 children will be forced onto Medi-CAL for the poor — which, of course, the state budget is already incapable of covering.

  3. Submitted by Dennis Tester on 09/23/2010 - 08:50 pm.

    When the government says that their new health care system will result in lower costs to the consumer by forcing insurance companies to provide a product that loses money, they are engaged in the great lie.

    Your insurance company will either drop the product or it will raise their premiums to cover the cost. Either way you lose.

    If you learn anything from the debacle that is Obamacare, it should be this: When the government attempts to control the marketplace for the good of the people, they end up controlling the people for the good of the marketplace.

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