Healthcare reform passed over two years ago and many Americans are scratching their heads trying to figure out how it has helped them. Most Americans (more than 250 million) have health insurance coverage through their employer or through Medicaid or Medicare, about 40 million or so are uninsured, and around 10 million Americans buy their medical insurance through private carriers.
So, the main benefits that group health insurance policy holder have seen is that adult children can stay on their policy until they turn 26. This benefit is only a benefit to those young adults who have medical conditions and are not eligible for individual health insurance.
A benefit which applied to all carriers is that lifetime dollar limits no longer apply. This benefit does help the most severely ill people, but also causes a great deal of financial burden to the insurance carriers. Even a 10 million dollar life time max, would have helped control the costs of our healthcare premiums.
Most of the changes have applied to the smallest group, which is the individuals and families who provide their own coverage. Now children younger than 19 can get covered by all carriers even if they had a disability or illness before signing up for the policy. However, child policies are no longer offered in most states, so children must be on a policy with their parents.
The individual markets also appreciate enhanced preventive services like annual check-ups, physicals, well baby visits, OBGYN, mammograms, PSA tests, vaccines and other preventive services are covered 100% when being treated in-network.
Supposedly, all health plans have a new built in law called patient protections but the exact details of this law seem uncertain at this time, but are designed to give the applicants and members more rights to appeal carrier decisions about eligibility for new coverage. And a policy can still be rescinded only if the member is involved in fraud.
Carriers are also required to pay out 80% of premium in claims. Some carriers such as Blue Shield of California have issued rebates because their plan didn’t spend at least 80% of premiums on claims.
Lastly, people who have HSA’s or health savings accounts can only use the money for over-the-counter
medications if they have a prescription from a doctor. And going forward HSA owners pay 20% tax if they use HSA money for unapproved purchases. In years prior this penalty was only 10%.
It is expected by summer 2013 the federal government will have a better understanding of how coverage will be administered. Some states already have begun using exchanges and high risk pools, but usually the applicant must go without any insurance for 6 months to be eligible and the insurance costs are so high, that the average American cannot afford the high premiums.