Home Page Retirement Planning Life & Health Insurance Medicare Benefits Estate Planning Safe Money Places Annuities Wills vs Trusts Tax – Free Retirement Be Your Own Bank ID Theft 10 Retirement Mistakes to Avoid The Great Wall Street Scam

Health Care Reform in 2011: What's Already in Effect, What's Still to Come

Here's your at-a-glance guide to the health care law provisions in effect now, as well as some still to come, and what they may mean for you.

Benefits and Provisions That Are in Effect Now

Insurance for People With Pre-existing Conditions: Adults whom private insurers consider to be "high-risk" due to prior or current health problems and who have been uninsured for at least six months are eligible to buy insurance through the federal Pre-Existing Condition Insurance Plan (PCIP) in their state. More

Coverage for Preventive Care and Screenings: People who have Medicare Part B as well as those covered by many individual and employer-sponsored health plans are eligible for free — i.e., no deductibles or copayments — preventive and wellness benefits, such as immunizations and screenings for diseases including cancer and diabetes. More

Medicare Part D "Doughnut Hole" Discounts: People with Medicare Part D who fall into the prescription drug coverage gap will receive a 50 percent discount on most brand-name prescriptions and biologic drugs, and a 7 percent discount on generic drugs. For 2011, the gap starts once the insured and the insurer have spent a combined total of $2,840 on prescriptions. Once a Part D customer's total drug costs reach $4,550 (see the Ms. Medicare column
"Paying Less for Drugs in the Doughnut Hole" for details about how this is calculated), his or her prescription costs drop to a lower "catastrophic coverage" copay for the remainder of the year. More 

Protections Against Insurance Cancellations: A common practice among insurers seeking to deny payments for costly medical care has been to re-examine customers' initial applications and cancel or "rescind" policies. The health care law prohibits insurers from rescinding a customer's health coverage because of unintentional mistakes or minor omissions on an application. More

No More Lifetime Limits on Care: Insurers can no longer limit how much they will pay out in essential medical benefits over a person's lifetime.
More

Higher Threshold for Annual Limits on Care: Most insurance plans that start between now and September 2011 must cover medical expenses up to at least $750,000 per year. (See below for more about annual coverage limits).
More

Protections for Children With Pre-existing Conditions: Under most individual and group insurance plans, children up to age 19 with prior or current health problems can no longer be denied coverage.
More

Coverage for Adult Children Age 26 and Under: Young adults who don't have access to an employer health plan now can stay on a parent's health insurance policy until they turn 26, even if they are married or don't live at home. Previously, most insurance plans kicked young adults off family policies when they turned 18 or, if the young adult was in college, soon after graduation.
More

Well-Baby and Child Health Care: Children are eligible for free annual wellness exams and immunizations from birth to age 21.
More

Expanded Right of Appeal: If an insurer rejects a claim or cancels coverage, customers of most plans now have the right to appeal the decision to an outside review panel. Unlike in the past, insurers will have to abide by that group's findings. More

More Consumer Protections
: Among the "patient bill of rights" provisions in effect now are rules that prevent insurance companies from requiring primary-care physician referrals for ob/gyn visits or out-of-network emergency care. More

Koch Insurance Brokers, LLC
            336 Anvil Dr. | Douglassville, PA 19518 | Ph. 610.370.7268 | TF: 888.410.4573