The next effective date of benefits of health reform is coming up. Here are some of the key provisions that will take effect on January 1, 2011:
FREE PREVENTIVE CARE FOR SENIORS—Under reform, beginning on January 1, 2011, the more than 40 million seniors in Medicare will begin receiving significant savings by getting preventive services such as mammograms and colonoscopies, and an annual wellness visit, without copayments, coinsurance, or deductibles.
50% DISCOUNTS FOR SENIORS WITH HIGH PRESCRIPTION DRUG COSTS—Under reform, beginning on January 1, 2011, those millions of seniors whose drug costs are so high that they end up in the Medicare Rx drug ‘donut hole’ coverage gap will begin getting a 50% discount on brand-name drugs in the donut hole, with growing discounts in future years until the donut hole is completely eliminated in 2020.
REQUIRING INSURANCE COMPANIES TO SPEND MORE ON MEDICAL CARE AND LESS ON EXECUTIVE PAY AND PROFITS—Beginning on January 1, 2011, health reform requires health insurance companies to spend at least 80 to 85 percent of consumers’ premium dollars on medical care and quality improvement, instead of on profits and such overhead costs as executive compensation and advertising. In addition, under reform, insurance companies are required to pay rebates to consumers if they fail to meet that standard. These new requirements will also bring a whole new level of transparency to the health insurance marketplace and hold the insurers accountable.
KEY PROVISIONS ALREADY IN EFFECT:
THE PATIENT’S BILL OF RIGHTS:
NO RESCISSIONS—Bans all health plans from dropping people when they get sick.
NO DISCRIMINATION AGAINST CHILDREN WITH PRE-EXISTING CONDITIONS—Prohibits all employer plans and new plans in the individual market from denying coverage to children with pre-existing conditions.
COVERAGE FOR YOUNG ADULTS UP TO AGE 26—Requires insurers to allow young people up to their 26th birthday to remain on their parents’ insurance policy, at the parents’ choice.
NO LIFETIME LIMITS—Prohibits all health plans from placing lifetime limits on coverage.
ANNUAL LIMITS PHASED OUT—Phases out the use of annual limits on coverage by health plans over the next three years.
FREE PREVENTIVE CARE FOR THOSE IN NEW PLANS—Requires new plans to cover preventive services such as mammograms and colonoscopies without copayments, coinsurance, or deductibles.
RIGHT TO INDEPENDENT, THIRD PARTY APPEALS PROCESS IN NEW PLANS—Requires new plans to provide consumers the right to appeal the plan’s denial of coverage to an independent third party.
Other key provisions:
SMALL BUSINESS TAX CREDITS—Offers tax credits of up to 35 percent of employer premium contributions (rising to 50 percent in 2014) for those small businesses that choose to offer coverage.
IMMEDIATE HELP FOR THE UNINSURED WITH PRE-EXISTING CONDITIONS —Provides immediate access to insurance for Americans who are uninsured because of a pre-existing condition – through the establishment of Pre-Existing Condition Insurance Plans in each state. These plans will exist until the Exchanges are up and running in 2014.
HELP FOR EARLY RETIREES—Provides a temporary re-insurance program (until the Exchanges are available) for employer health plans providing coverage for early retirees, helping to protect coverage while reducing premiums for employers and these early retirees age 55-64.
HOLDS INSURANCE COMPANIES ACCOUNTABLE FOR UNREASONABLE RATE HIKES—Provides grants to support states in requiring health insurance companies to subject justification for requested premium increases.
COMMUNITY HEALTH CENTERS—Increases funding for Community Health Centers to allow for nearly doubling the number of patients served over the next 5 years.