Much of the federal
healthcare reform that passed in March 2010 will not take effect
until 2014. However, key parts of the legislation began this fall,
offering expanded insurance benefits and protections to members of
the bleeding disorders community now and during the next year.
End of Lifetime Limits
Beginning
September 23, 2010, as individual
and group health plan policies are
issued or renewed during the next
year, they will no longer have
lifetime limits. By September 22,
2011, no health plan will have a
lifetime limit.
Annual Limit Minimums
Until
January 1, 2014, when annual limits
for all insurance plans will be
abolished, the law sets a minimum
annual limit dollar amount for all
group policies and new individual
policies. (However, the law does not
apply to existing individual
policies.) For a plan or policy year
beginning between September 23,
2010, and September 22, 2011, the
minimum annual limit can be no less
than $750,000. That amount will
increase in subsequent years.
Addressing Pre-Existing Condition
Exclusions
Individual
and group health plan policies
issued or renewed on or after
September 23, 2010, will no longer
be permitted to exclude or restrict
coverage for an individual younger
than age 19 with a pre-existing
condition. By September 22, 2011, no
policy will be able to exclude this
group.
End of Insurance Plan Cancellations
As of
September 23, 2010, individual and
group health plans cannot cancel an
insurance policy because an
individual had high-cost medical
claims.
Medicare Drug Benefit Savings
This year,
Medicare will provide a one-time
$250 rebate to help pay for
prescriptions in the “donut hole,” a
gap in Medicare Part D coverage that
occurs when drug costs exceed the
initial coverage limit, but do not
reach the catastrophic coverage
threshold. In 2011, there will be a
50% discount on covered brand-name
prescription drugs for those in the
donut hole.
Coverage for Children
All
children younger than 19, regardless
of medical condition, must be
accepted by individual plans for an
individual policy (for the child) or
as a dependent under an approved
family policy.
New Dependent Coverage Limit
The law
requires all insurance plans that
offer dependent coverage under a
parent’s policy to provide it until
an adult child turns 26, whether
single or married. The only
exception is if the parent has an
employer-based plan and the child is
eligible for his or her own
employer-based coverage. By
September 22, 2011, all eligible
adult children should be enrolled.
New Pre-Existing Condition Insurance
Plans
If you
have a pre-existing condition and
have been without insurance for six
months or more and have no insurance
options, the law has created a
pre-existing condition insurance
plan in each state. Often referred
to as temporary high-risk pools,
these plans will serve as a bridge
until 2014, when all individuals,
including those with pre-existing
conditions, will be able to purchase
qualified individual plan coverage
through state-based American Health
Benefit Exchanges.
The material provided in Headline
News is for your general information
only. GLHF does not give medical
advice or engage in the practice of
medicine. GLHF under no
circumstances recommends particular
treatment for specific individuals,
and in all cases recommends that you
consult your physician or treatment
center before pursuing any course of
treatment.
