Healthcare Reform Insurance Provisions

                           U.S. Healthcare Reform Insurance Provisions

Concern

Reform Provision

Effective Dates

 

Pre-existing Medical Condition

Interim coverage via high-risk insurance pools

June, 2010 to 12/2013

 

Insurers barred from rejecting applicants due to pre-existing conditions

1/1/2014 via Health insurance exchanges

Insurance Limits on Coverage

Insurers barred from selling policies with lifetime limits

Sept., 2010

 

Insurers barred from selling policies with annual limits

1/1/2014

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
       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):

  • Greater of $95 or 1% of   income per individual;
  • Greater of $325 or 2% of income per individual;
  • Greater of $695 or 2.5% of income per individual;
  • Total household penalty may not exceed $2,085.
                        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
Young Adults Those under 26 years old can stay on parent’s health insurance if not offered health insurance via work.

                     Sept.2010
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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