Much was made of the size and complexity of the Patient Protection and Affordable Care Act when President Obama signed it into law in 2010. But now that the Supreme Court has upheld much of the act’s constitutionality, it’s a good time to review key provisions that have already gone live and to plot out what’s expected to happen in the next two years.
Changes already in place include:
- Children under 19 cannot be denied coverage because of preexisting conditions.
- Adult children may remain on parents’ medical plan until they turn 26.
- Lifetime insurance maximum payouts were eliminated. In addition, annual coverage limits are being phased out. Effective September 23, 2012, the annual limit increases to $2 million.
- All new plans now must provide certain preventive services for free, such as mammograms, immunizations and colonoscopies.
- People who’ve been refused insurance because of preexisting conditions may now be eligible for coverage through a “high-risk pool” program. Go to https://www.pcip.gov/for information and to apply online.
- Medicare Part D participants who reach the infamous doughnut hole now receive a 50 percent discount on brand-name prescription drugs – 14 percent on generics. (These discounts will gradually increase until 2020 when the doughnut hole will disappear.)
Many core features of the Affordable Care Act won’t take full effect until 2014 and details are still being finalized, but here are highlights of what’s expected to happen between now and then:
- By August 1, 2012, insurance companies that didn’t spend at least 85 percent of 2011 premium dollars for large group plans (over 50 employees) on medical care must refund the difference, through refund checks or discounted future premiums (80 percent for individual or small group plans).
- By October 1, 2012, plans must begin adopting rules for the secure electronic exchange of health information – this will reduce paperwork, costs and medical errors.
- By January 1, 2013, new federal funding will be in place to state Medicaid programs that choose to cover preventive services to patients at little or no cost.
- By October 1, 2013, states will receive two additional years of funding to continue coverage for children not eligible for Medicaid.
Effective January 1, 2014, most key provisions will be in place. For example:
- Individuals and those whose employers don’t offer health insurance will be able to buy it directly from state-based Affordable Insurance Exchanges, which will offer a choice of health plans that meet certain benefits and cost standards.
- Most who can afford basic health coverage will be required to obtain it or pay a fee to offset the costs of caring for uninsured Americans.
- Americans earning less than 133 percent of the poverty level will be eligible to enroll in Medicaid.
- Refundable tax credits will be available to those earning between 100 and 400 percent of the poverty level to help pay for affordable insurance. They also may qualify for reduced copayments, coinsurance and deductibles.
- Annual coverage dollar amount limits will be prohibited.
- Adults will no longer be refused coverage due to preexisting conditions.
- Insurance companies will no longer be able to charge higher rates to individuals and small groups due to gender or health status.