Healthcare reform kicks in Thursday
While the full healthcare reform plan doesn't kick in until 2014 and the debate about its eventual effects and costs continues, most insured Americans will see immediate changes. Yet the changes aren't well understood by most Americans, according to a new Associated Press poll.
The changes generally apply to new plans -- employer group plans will adopt the changes either at the beginning of a new plan year or when a plan undergoes any major revamping -- but it won't be long before most plans see some impact.
Here's a look at the new benefits:
Ban on lifetime coverage limits
The legislation bans insurance companies from setting lifetime coverage limits, a move that could bring considerable help to families facing long term care for illnesses that can run hundreds of thousands of dollars annually.
Faced with the maximum limits, people were reportedly having to switch jobs to stay insured.
As of Thursday, a maximum limit is banned for new plans; the ban starts for current group and individual plans at the beginning of the plan year.
Insurance plans can still set annual coverage limits, at least for the moment. It's the lifetime limits that are getting blocked.
Still, the reform restricts how far the limits can go. This year, the annual limit can be no lower than $750,000 for new plans. The limit grows to $2 million in two years and disappears entirely in 2014 for all group plans and all new individual plans.
Coverage of children to age 26
In one of the biggest changes to take effect Thursday, children can stay on their parents' plan up to age 26. That's true even if the child is no longer a student, no longer lives at home or is married (though his or her spouse can't be covered).
That's significant, considering an estimated 30% of young adults are currently not covered by health insurance.
There are a few conditions: First, this applies to any health plan that offers dependent coverage. Second, an employer doesn't have to cover a working youth who can get other health care coverage at his own workplace.
The requirement applies to new plans immediately and to existing group plans at the beginning of the plan year.
Parents should get plenty of notice about the possibility from employers, because group plans have to give parents 30 days to enroll their children. Some insurers began offering the age 26 coverage early.
Older youths have to be covered at the same rate as younger children. There's been some indication that even though parents can avoid buying separate health care coverage for their older children, they could find their employers raising premiums for family coverage.
Free preventative health care and easier choice of doctors
All new plans have to cover a number of preventative services without charging either a deductible or co-pay, starting Thursday. Among the services that must be provided are immunizations, colonoscopies and mammograms.
In addition, the new law makes it easier to choose and see pediatricians, gynecologists, and obstetricians without having to obtain a referral. One of the arguments for healthcare reform was that the lack of preventative care caused higher health care bills later on.
The healthcare reform legislation also bars "out of network" charges for some emergency services.
Bar on denying coverage to kids with preexisting conditions
The new law bars health plans from denying coverage to children under 19 with preexisting conditions. It applies to new individual plans and employer group plans as of Thursday.
The change was intended both to prevent insurance companies from turning down a family for coverage because of a child's condition or refusing to pay for an illness because a child's condition was preexisting.
The requirement applies to new individual plans and existing group plans immediately.
There were reports this week that several insurance companies were sidestepping the new requirement by no longer writing separate coverage for children, but some of those children could now find it easier to get coverage under employer plans.
Bar insurers from rescinding coverage
Insurers can no longer use technical mistakes on a customer's application for coverage to years later deny coverage for sickness. During the healthcare reform debate, reports of incidents of breast cancer patients losing their coverage prompted insurance companies to voluntarily end the practice, but the law makes the practice illegal, except for fraud.
Appealing insurance company decisions
The law requires insurance companies to set up an outside appeals process for claims that are denied. The change takes effect for new plans on Thursday.