Peninsula Daily News news services
The nation’s new health care law turns 6 months old today (Thursday, Sept. 23) and starts delivering protections and dollars-and-cents benefits that Americans can grasp.
But it won’t affect all consumers the same way, which may cause confusion.
Q. Will everyone’s health insurance change today?
A: No. It depends on when your health insurance plan year starts.
Many of the new requirements begin with plan years starting on or after today.
But if your plan year starts Jan. 1, as many do, that’s when the changes start.
“Grandfathered” plans, those that existed before the law was enacted March 23 and which remain essentially unchanged, must meet only some of the requirements.
New plans and those with significant changes in benefits or out-of-pocket costs must comply with even more changes in the law.
Q: Why today?
A: That’s six months after President Obama signed the law.
Many provisions were scheduled to start six months after enactment.
Q. I get my coverage through work, and the “open enrollment” period is approaching.
I’d like to keep my current health plan.
Will the new law affect it?
A. Your plan will feature new consumer protections.
For example, a lifetime limit on coverage is not permitted.
If you have an adult child up to age 26 who can’t get health insurance at a job, you’ll be able to keep him or her on your health plan.
These changes kick in for plan years that begin on or after today.
If your employer makes significant changes, such as cutting benefits or raising out-of-pocket costs beyond a specific amount, the plan is considered new — rather than an existing “grandfathered” plan — and must include a wider set of consumer protections.
Patients will receive, for example, certain preventive services such as breast-cancer screenings and cholesterol tests without paying deductibles or co-payments.
They will be able to see obstetricians and pediatricians without prior authorizations.
Recommended immunizations also will be free.
Q. What if my employer offers a new plan and I want to switch to that?
A. In that case, your coverage would include the wider set of protections.
Q. Will my health insurance cost less?
A. Probably not. Premiums have been increasing steadily over the past decade, and that trend is continuing.
Workers nationwide on average are paying 14 percent, or $482, more for family health-insurance coverage this year.
A recent study by the National Business Group on Health found that almost two-thirds of employers planned to shift more premium costs to employees.
Q. I’m a small-business owner. Do I have to offer coverage to my workers this fall?
If so, will the government help me pay for it?
A. No business owner — small or large — is required to offer coverage.
However, small businesses with 25 or fewer full-time employees who earn an average yearly salary of $50,000 or less will qualify for a tax credit of up to 35 percent of the cost of premiums.
The credit increases to 50 percent in 2014 for most small employers.
To qualify for credits, businesses must cover at least 50 percent of the cost of workers’ insurance.
Starting in 2014, businesses with 50 or more employees that don’t provide coverage and have at least one full-time worker who receives subsidized coverage in the health-insurance exchanges will have to pay a fee of up to $2,000 per full-time employee.
(The firms’ first 30 workers will be excluded.)
Smaller businesses will be exempt.
Q. I buy my insurance. How will the law affect my coverage?
A. For policy years that start after today, all policies in the individual market will be barred from canceling coverage once you get sick — a practice known as “rescission” — unless you committed fraud when applying for coverage.
Insurers will be prohibited from setting lifetime limits.
Plans also must allow an adult child up to age 26 on your health plan if he or she can’t get coverage through a job.
New policies can’t deny coverage for children up to age 19 based on pre-existing medical conditions.
“Grandfathered” plans can, however; they also can set annual dollar limits on coverage and require patients to help pay for some preventive services.
Most people in the individual market are expected to move to new plans by 2014.
Analysts say most plans in the group market also probably will have lost their “grandfathered” status because of changes made to them.
Other provisions of the law will kick in later.
For example, as of 2014, insurers won’t be able to refuse to cover adults who have pre-existing conditions.
That same year, individuals whose incomes are up to 400 percent of the poverty level — $88,200 for a family of four — will qualify for subsidies to help purchase health insurance on exchanges, or marketplaces
where consumers can shop for coverage.
At that point, most people must have health insurance or pay a fine.
Q. I’m on Medicare. Will my benefits change?
A. Your basic package of Medicare benefits will expand.
If you’re in a Medicare Advantage plan, however — a private plan that offers Medicare benefits — you might lose extra benefits at some point.
In terms of the Medicare program overall, let’s start with prescription drugs.
As of late August, 1 million beneficiaries had received $250 checks to help cover prescription-drug costs in what’s known as the doughnut hole — the coverage gap in which beneficiaries must pay the full cost of prescriptions until catastrophic coverage kicks in.
Starting next year, beneficiaries will receive 50 percent discounts on brand-name drugs and 7 percent discounts on generic drugs while in the coverage gap.
The gap closes entirely by 2020.
In addition, beginning next year, Medicare beneficiaries won’t pay co-payments or deductibles on many preventive services, including diabetes and cervical-cancer screenings.
A yearly wellness visit to the doctor will be covered, too.
To help pay for the health overhaul, Congress is cutting payments to Medicare Advantage plans, beginning in 2012.
Beneficiaries won’t lose basic Medicare benefits, but some Medicare Advantage insurers could stop offering additional benefits such as coverage for eyeglasses or gym memberships.
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Sources: Associated Press. Kaiser Family Foundation.
