Health care reform is on the top of people’s minds and has been for years and years. For good reason, many Americans are concerned about medical care and health care costs. While Health Care Reform is certainly moving forward, it is hard to know what is fact and what is fiction.
FACTS On the Affordable Care Act:
The Affordable Care Act was passed on December 24, 2009, and signed into effect in March of 2010. While many of the provisions of the act have yet to come into action, some portions of the Affordable Care Act have already taken effect. These changes include allowing young adults under the age of 26 to remain on their parent’s health care plan regardless of marital status, plus the addition of an appeals process for claim denials.
Most of the provisions of the Act, however do not take place until January, 2014. These changes include: The pre-existing medical conditions clause, which provides that insurers are not allowed to deny coverage for, charge higher fees or add exclusions to a policy due to a pre-existing condition. This takes effect for all patients no matter their age.
FACTS on Health Insurance Annual Limits:
The annual limits clause, which prohibits annual limits from being set on an individual and/or group plans. By prohibiting all insurance plans from placing lifetime caps on the amount spent on benefits, patients do not have to worry about losing access to care after reaching their lifetime caps when dealing with long term illnesses or injury. The guaranteed issue and renew-ability clause, which states that insurers must accept every applicant (both employer and individual), it also requires that the insurer guarantees renew-ability of said policy, no matter the situation or medical condition.
FACTS on Health Insurance Exchanges:
The health insurance exchanges clause, which provides that individual states may create an insurance exchange for small group as well as individual health plans. These exchanges offer a variety of choices in coverage. There will also be an exchange ran by the federal government provided for residents of states that choose not to create an exchange. The benefits package clause requires all individual and group plans through Exchanges must have an “essential benefits” package which consists of: Rx drugs, mental health treatment (including addictions) in addition to some preventative services including cancer and diabetes screening as well as blood pressure checks and flu shots.
The premium assistance clause will also take effect. This clause states that assistance will be provided to individuals when the cost of the policy exceeds a certain percentage of that policy holders income.
The individual responsibility clause states that most individuals will be required to maintain health insurance coverage. Those who do not comply with this requirement will receive tax penalties, however, there are exceptions for financial hardships or religious objections.
FACTS on Medicaid:
A new requirement placed upon individual states is also in effect. The states will be required to grow Medicaid eligibility up to 133% of poverty level for all non-elderly individuals. Prescription coverages will also be changed. Previously denied prescriptions of Benzodiazepines and barbiturates will be required to be covered on state Medicaid prescription plans. The enrollment assistance clause requires that individual states create a health insurance website which help individuals apply and/or renew their Medicaid, CHIP or Exchange plans. These websites must allow the policy holder to compare benefits and premiums. These comparisons must be able to be made with Medicaid as well as other plans.
In addition to these clauses that will be taking effect in 2014, the new health care law uses tougher screening procedures, stronger penalties and new technologies aimed at preventing fraud. In summation, the Affordable Care Act provides many changes and expansions to health care options. These changes include consumer protections for policy holders, tax credit for small business owners and no concerns for people with pre-existing conditions who need health insurance at a rate they can afford.
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