The Affordable Care Act was signed into law on March 23, 2010. Like most of us, you probably have many questions: "How does health reform affect me?" "When will new changes occur?" "What is Virginia doing to implement the new health laws?"
Many benefits of the new law have already been implemented, with others being phased in over the next few years. There are three main areas of benefits and changes:
1. Improving Health Care Access and Quality
2. Making Health Care More Affordable and Expanding Benefits through Medicaid and Medicare
3. Reforming Health Insurance, Expanding Private Health Insurance Plan Benefits
Click on one of the three topics to see detailed information on current and future changes:
- Improving Access and Quality
- Making It More Affordable
- Reforming Health Insurance
Improving Health Care Access and Quality:
NOW:
- People who have been uninsured for six months and have pre-existing health conditions are eligible for the new Pre-Existing Condition Insurance Plan (PCIP). This covers a broad range of health benefits, specialty and hospital care, and prescription drugs, building a bridge in coverage to 2014.
- Tools have been created to allow you to compare a variety of quality measures of health care and service providers at www.healthcare.gov/compare/index.html.
IN THE WORKS:
- People with low or no income will have greater access through an expanded network of community health centers.
- People living in medically underserved areas will have access to more primary care providers as a result of an expanded National Health Service.
- Virginia has new opportunities to expand and improve home and community based services to disabled individuals through Medicaid rather than institutional care in nursing homes.
Making Health Care More Affordable and Expanding Benefits through Medicaid and Medicare:
NOW:
- Prescriptions: Medicare recipients in the part D "donut hole" receive a 50% discount on covered, brand name prescription drugs and a 7% discount on generic drugs.
- Preventive Care: Medicare and private insurance recipients are eligible for free preventive care such as annual wellness checkups and cancer screenings.
2014:
- Americans who earn less than 133% of the poverty guidelines will be eligible to enroll in Medicaid.
- Employers with more than 200 employees are required to offer health insurance.
- People without employer-based insurance and employers with 100 or fewer employees can purchase affordable insurance through a state-based health insurance exchange. Those with low and middle incomes can receive a tax credit to help pay for the coverage with limits on out-of-pocket costs.
- Employers of 50 or more employees will be required to provide health insurance and U.S. citizens and legal residents will be required to have health insurance or pay a tax penalty, unless exceptions apply.
2020:
- The "Donut Hole" will be closed.
Reforming Health Insurance, Expanding Private Health Insurance Plan Benefits:
NOW:
- Insurers cannot cancel your coverage if you become sick.
- Insurers must get permission from the Federal government to cap the dollar amount they will pay in health care for a person over a lifetime.
- Insurers must phase out annual limits on certain services.
- Insurers cannot deny coverage to anyone under 18 years of age based on pre-existing conditions.
- Consumers have new appeal rights and procedures if insurers deny care or payment for services.
- States will review large premium increases to ensure they are reasonable avoiding unjustifiable hikes.
- Young adults can remain on parent's insurance plans until age 26 (without regard to their educational or marriage status or residency).
- Insurers must spend 80-85% of premiums received on actual health care.
- Small employers with 25 or fewer employers and average annual wages of less than $50,000 receive a tax credit for providing employee health insurance.
- Private and group health plans must provide a uniform summary of benefits of coverage (SBC) to all applicants and enrollees.
2014:
- Insurers cannot cap the dollar amount they will pay in health care for a person over a lifetime.
- New health plans must sell policies to all new applicants regardless of health status.
- New health plans cannot charge higher premium rates based on gender or health status.
- Insurers cannot deny coverage based on pre-existing conditions.
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