U.S. Healthcare Reform Insurance Provisions
Concern |
Reform Provision |
Effective Dates |
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Pre-existing Medical Condition |
Interim coverage via high-risk insurance pools |
June, 2010 to 12/2013 |
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Insurers barred from rejecting applicants due to pre-existing conditions |
1/1/2014 via Health insurance exchanges |
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Insurance Limits on Coverage |
Insurers barred from selling policies with lifetime limits |
Sept., 2010 |
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Insurers barred from selling policies with annual limits |
1/1/2014 |
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Medicare Beneficiaries |
Improved medication coverage: $250 federal reimbursement for those paying for medications in Medicare drug “doughnut hole”; Drug companies required to give 50% discount on brand name drugs for prescriptions filled in “doughnut hole” (out-of-pocket) |
2010
2011 |
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Mandated Insurance | Out-of-pocket “doughnut hole” payments eliminated;Medicare Advantage (private plan) frozen in 2011 and cut back over time, reducing benefits like free eyeglasses and hearing aids;Free screenings for colon, prostate, & breast cancer (seehealthcare.gov/center/regulations/prevention/taskforce.html for complete list; large employer plans and plans operating before 3/23/10 exempt unless plans change terms). Penalties for failure to buy qualified insurance (x 50% for individuals in household < age 18):
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By 2020
By 2018 (in high-cost parts of U.S.)
9/23/2010 1/1/11 Medicare/Medicaid 1/1/2014 1/1/2014 1/1/2015 1/1/2016 |
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Young Adults | Those under 26 years old can stay on parent’s health insurance if not offered health insurance via work. |
Sept.2010
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Premium Subsidies | Eligible individuals & families include those with incomes between 133% and 400% of federal poverty levels, = $14,404-$43,320 for individuals and $29,326-$88,200 for families of four (sliding scale) | 1/1/2014 | |||
Medicaid Eligibility | Expands in 2014:Low-income adults, including with no children, eligible if income <133% of federal poverty level, = $14,404 for individuals and $29,326 for family of four using 2010 income guidelines. | 1/1/2014 | |||
Source: Technical Explanation of the Revenue Provisions of the “Reconciliation Act of 2010”, As Amended, In Combination with the “Patients Protection and Affordable Care Act”, Joint Committee on Taxation, 3/21/10; Consumers Guide to Health Reform. Kaiser Health News, 4/1/3/2010.
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