Health Care Reform Benefits
The Patient Protection and Affordable Care Act (PPACA) is a United States federal statute signed into law by President Barack Obama on March 23, 2010. The law (along with the Health Care and Education Reconciliation Act of 2010) is the principal health care reform legislation of the 111th United States Congress. PPACA reforms certain aspects of the private health insurance industry and public health insurance programs, increases insurance coverage of pre-existing conditions, expands access to insurance to over 30 million Americans, and increases projected national medical spending while lowering projected Medicare spending.
Provisions that have taken effect as of January 2012
Seniors in Medicare who reach the coverage gap receive 50% discount on Part D covered brand name drugs.
Seniors in Medicare will receive increasing Part D brand name drug savings until coverage gap is closed in 2020.
Young adults are allowed to stay on their parent’s health insurance plan until they turn 26.
Pre-existing Condition Insuranace Plan (PCIP) available for those who have been denied coverage and without insurance for 6+ months.
Small buisinesses can receive tax credit up to 35% of their employer contribution towards employee health insurance benefits.
Non profits can receive tax credit up to 25% of their employer contribution towards employee health insurance benefits.
Federal matching funds were increased for states to expand Medicaid program to cover more low income families.
Additional resources have been allocated to reduce fraud and waste in Medicare, Medicaid and CHIP. $2.5 billion was returned in 2009.
Enhanced enrollment and screening requirements to detect fraud on the part of Medicare providers.
New requirements for suppliers of Medicare Durable Medical Equipment to reduce fraud
Extra help for employment based plans to continue affordable health insurance for people who retire before 65.
More information on line to help people compare health insurance coverage at www.healthcare.gov
All new plans include preventive office visits at no charge.
A policy can only be rescinded (canceled) if the member intentionally misrepresents facts on the application.
There are no longer lifetime dollar limits on key benefits like hospital stays or treatment.
Children under 19 can get health insurance even if they have a pre-existing condition or illness before applying.
Certain preventative services like vaccines are covered 100% in network.
Adult Preventive Services covered in all health plans without having to pay any cost sharing, deductible or co-payment for office visits:
Abdominal Aortic Aneurysm
Alcohol misuse, sceening and counseling
Aspirin use for men and women of certain age
Blood Pressure screening for adults
Cholesterol screening for adults of certain age and risk
Colorectal Screening screening for adults over 50
Depression screening for adults
Type 2 Diabetes screening for adults with high blood pressure
Diet counseling for adults at risk for chronic disease
HIV screening for adults at high risk
Immunizations, covers a spectrum of ages and types
Obesity screening and counseling
Sexually Transmitted Infection prevention counseling for adults
Tobacco Use cessation and intervention
Anemia screening for pregnant women
Breast Cancer Mammography, women over 40, every 2 years.
Breast Cancer Chemoprevention, counseling for women at risk
Cervical Cancer screening for women
Chlamydia Infection for younger and women at risk
Folic Acid supplements for women who might become pregnant
Gonorrhea screening for women at risk
Hepatitus screening for pregnant women at their first prenatal visit
Osteoporis screening for women over 60 at risk
Syphilis screening for women at risk
Additional Women’s Preventive Services effective in policies issued after August 1, 2012:
Well Women visits
Gestational diabetes screening
Human Papillomavirus testing for high risk and normal cytology results
Counseling for sexually transmitted infections and HIV
Contraceptive Methods including sterilization, counseling
Breastfeeding Support supplies and counseling
Interpersonal and Domestic Violence screening and counseling
No charge preventive services for children
Alcohol and Drug use assessments in adolescents
Autism screening 18 to 24 months
Blood pressure screening at various age ranges
Cervical Dysplasia screening for sexually active females
Congenital Hypothyroidism screening for new borns
Depression screening for adolescents
Dyslipidemia screening for children at high risk of lipid disorders
Fluoride Chemoprevention supplements for children
Gonorrhea preventive medication for the eyes of all new borns
Hearing screening for all new borns
Hematocrit or Hemoglobin screening for all children
Immunizations from birth to 18 for a variety of diseases
Iron supplements for children 6 – 12 months at risk of anemia
Lead screening for children at risk of exposure
Obesity screening and counseling
Oral Health risk assessment
Phenylketonuria (PKU) screening for this genetic disorder in new borns
Sexually Transmitted Infection prevention for adolescents at risk
Tuberculin testing for children of higher risk of tuberculosis
Vision screening for all children
Members may be eligible for a rebate if plan doesn’t spend at 80% of premiums on medical care and quality improvement during the year.
HSA money can only be spent on over-the-counter if plan member has a prescription.
Benefit summaries will start to use standard format that makes it easier to compare plans.
Accountable Care Organizations, in these groups, doctors can better coordinate patient care and improve the quality
Value-Based Purchasing program (VBP) in Original Medicare. This program offers financial incentives to hospitals to improve the quality of care
Standardize billing and requires health plans to begin adopting and implementing rules for the secure, confidential, electronic exchange of health information
Medicare Shared Savings program, allowing ACOs to contract with Medicare
Requires states to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services
National pilot program, bundling payments, to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care
States will receive two more years of funding to continue coverage for children not eligible for Medicaid
Affordable Insurance Exchanges, competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans.
Members of Congress will be getting their health care insurance through Exchanges
All plans must included certain “essential health benefits”
Plans must cover at least 60% of costs for in-network covered services.
Plans must fit into five categories that cover between 60% to 90% of all costs
A ‘catostrophic coverage’, least expensive, will be available for people under 30 or with financial hardship.
Most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans
If affordable coverage is not available to an individual, he or she will be eligible for an exemption
Workers meeting certain requirements who cannot afford the coverage provided by their employer may take whatever funds their employer might have contributed to their insurance and use these resources to help purchase a more affordable plan in the new Affordable Insurance Exchanges
Americans who earn less than 133% of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid
Tax credits to help the middle class afford insurance will become available for those with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage
Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial
The law prohibits new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual may receive
“Guarantee Issue” will prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditionsPlans may not charge higher premiums due to gender or health status.
Small business tax credit for employer contribution to employee health insurance will increase to 50%
Non-Profit tax credit for contribution to the employee health insurance will increase to 35%.
Physician payments will be tied to the quality of care they provide
For more information and a complete list of benefits visit www.healthcare.gov
Questions and Answers
Aren’t Colonoscopies Free under Healthcare Reform Law? Kaiser Health News explains some of the situations http://bcove.me/c7d5v5jz