The new healthcare law, called the Patient Protection and Affordable Care Act (PPACA), was enacted on March 23, 2010. The goal of health reform is to: 1) allow individuals with pre existing conditions to get access to low cost medical insurance, 2) provide increased consumer protection, and 3) make medical insurance more affordable for all Americans. The regulations will be phased in over a four year period.
As of September 23, 2010, the following provisions of the new healthcare law become effective:
- Each state must implement the Pre Existing Conditions Insurance Plan, per the new healthcare law’s guidelines. This new health insurance plan is designed to provide affordable medical insurance to those eligible individuals that would otherwise not qualify for an individual medical insurance plan because of their health status.
- No out-of-pocket costs for preventive care. You cannot be charged co-payments, deductibles or co-insurance for flu and pneumonia vaccines; counseling for a range of conditions from smoking, depression and weight loss; healthy pregnancy counseling, screening and vaccines and well baby and well child visits from birth to age 21; and a variety of preventive screening services for adults, such as cancer.
- Sick children (less than age 19) cannot be excluded when applying for medical insurance, and health insurance companies must cover pre existing condition of children.
- Parents’ medical insurance plans must allow young adults to remain covered up to age 26, regardless of student, financial, employment or marital status.
- No dropping sick people. Health insurance companies are banned from cancelling a person’s coverage on the individual market when they get sick.
- Medical insurance plans that have annual limits on covered healthcare expenses must increase the cap to comply with the minimum requirements (medical insurance policies are prohibited from placing low dollar caps on covered healthcare expenses).
- Medical insurance plans that contain a lifetime policy limit on covered healthcare expenses must remove the cap.
- Health insurers are required to implement an easier and faster claim appeal process for members that elect to dispute how a claim(s) is paid.
Other significant provisions that become effective beyond 2010:
- Minimum Loss Ratios or MLR (2011)- this provision requires health insurance companies to spend at least 80% percent of every premium dollar collected for individual medical insurance (85% for employer sponsored group health insurance) on the cost of healthcare for their members. Currently, many insurers only spend roughly 65% to 75% of every premium dollar collected toward the payment of claims.
- States are required to set up and maintain a health insurance exchange (2014). This quasi portal is supposed to enable consumers to shop for medical insurance online and have the federal subsidy (based on income) applied toward their health insurance premium.
- Requirement that all American’s purchase medical insurance or pay an IRS fine (2014). This is referred to as the widely contested and controversial “individual mandate.”
- Medical insurance policies must provide coverage for “Essential Benefits,” such as maternity (2014).
- Any adult applying for an individual medical insurance plan cannot be declined because they have a pre existing condition (2104). This is referred to as the “guarantee issue” requirement.
If you are currently unable to qualify for major medical insurance due to a pre existing health condition, then we can help you secure affordable medical insurance. Call us today and we can tell you if you are eligible for the new government Pre Existing Conditions Insurance Plan.