The new healthcare law affects virtually all Americans, old or young, working or unemployed, single or married. How much you are affected depends on your individual situation. Let’s take a look at certain groups and what healthcare reform means to them.
How the New Healthcare Law Affects Individuals
- Individual mandate: If you’re not covered by an employer-sponsored health plan, Medicaid, Medicare or other public insurance programs, you must buy an approved private insurance policy or pay a tax.
- Preventive care: Part of healthcare reform includes greater access to preventive care to improve the nation’s health and reduce overall spending by finding and treating diseases sooner. The new law prohibits cost-sharing for all preventive care provided within a non-grandfathered plan’s network, so you won’t be charged a copay or coinsurance or need to fulfill your deductible as long as you use a doctor within your plan’s network.
- Low income subsidies: If you have low income, but are not eligible for coverage through a government program, you can receive federal subsidies, depending on your income level, to buy private health insurance.
- Dependent coverage until 26: Generally, you can remain on your parents’ insurance through age 26. That age limit can change from state to state. For example, in Ohio, a child can stay on their parent’s plan until his or her 28th birthday.
- Affordable options: Starting in 2014, you may be able to purchase affordable health insurance through a health insurance exchange in your state. Health insurance exchanges are online marketplaces where individuals and small employers can buy health insurance. Individuals eligible for federal subsidies will use the subsidies when purchasing coverage on an exchange. The exchanges bring together insurance plans from multiple insurance companies so they can be easily compared.
- Pre-existing conditions: In 2014, it will be illegal for insurers to deny coverage because of pre-existing conditions, so these plans will eventually be phased out. Prior to 2014, if you had been without health coverage for the past six months and couldn't get coverage because of a pre-existing condition, you could be eligible for a Pre-existing Condition Insurance Plan or High Risk Pool plan. This is a federal program for people who cannot get coverage otherwise.
- Appeals: If you disagree with an insurance company’s decision about your coverage or claims, you can appeal to the company. If necessary you can appeal to an external authority. The ability to appeal a decision made by an insurance company existed before the Affordable Care Act was passed, but the law has made the appeals rules the same for each insurer and expanded your rights in every step of the appeals process.
What the New Healthcare Law means for Medicaid and Medicare
- Coverage and eligibility: Beginning in 2014, some state Medicaid programs will be expanded to cover all individuals under age 65 with incomes up to 133 percent of the federal poverty level ($15,4282 for an individual and $31,322 for a family of four).
- Free wellness visits: Medicare recipients receive free annual wellness visits with their physicians.
- Prescription Drugs (Medicare D): Healthcare reform gradually reduces the amount Medicare Part D enrollees pay for their prescriptions when they reach the coverage gap, or the point when their drug costs are highest. Enrollees already receive a 50 percent discount on the total cost of their brand-name drugs in the coverage gap. Additional discounts for the “gap” will be phased-in until 2020, so enrollees will eventually pay only 25 percent of the cost for generic and brand-name drugs. Healthcare reform reduces payments to Medicare Advantage plans to bring them closer to the average costs of traditional Medicare.