Benefits Summary Of Health Care Reform (some taking effect this week)

Quick summary of some health care reform taking effect this week to help millions:

1. Requiring that insurance companies cover people with pre-existing conditions.
2. Making it illegal for insurance companies to drop coverage for people who get sick.
3. Cracking down on unjustified premium hikes.
4. Placing a cap on out-of-pocket health care costs.
5. Extending coverage options to parents to insure children up to 26 years old.
6. Cutting waste, fraud and abuse from Medicare.
7. Providing free preventive care for seniors, including screenings for cancer.

Patient advocates say Thursday's changes are only the beginning. "The big resolutions will come in 2014 when you will start to see tens of millions of people getting coverage," says Avram Goldstein, communication director for the Health Care for America Now, a liberal grass roots health advocacy organization. It offers a detailed timeline of what changes consumers can expect over the next few years.

Here are six provisions that could affect you immediately if you purchase a new plan starting Thursday. For people who have an existing health care plan, these changes will take effect during open enrollment if you are covered through your employer, or when your current policy renews if you purchased a plan on the individual market.

Young people can remain on parents' insurance until age 26

The health care reform legislation requires insurance companies to allow dependent children to remain on their parents' insurance policies until their 26th birthday. The children can't have jobs that offer insurance.
According to the Department of Health and Human Services, several health insurers began early implementation of this policy in May, months ahead of the September 23 deadline.

Until Thursday, in most states dependents were booted off their parent's health insurance policy before age 26, sometimes as early as age 19. A handful of states allow dependents to remain on a parent's policy until age 30, and HHS says those locations will continue to do so. To find out the specifics for your state, go to Gettingcovered.org and look at the state facts or check the state-by-state "definition of dependency" list from the Kaiser Family Foundation.

No discrimination against children with pre-existing conditions

Starting Thursday, consumer protections prohibit all employer plans and all new plans in the individual market from denying coverage to children age 18 and younger who have pre-existing conditions.

However, ahead of this provision, several large health insurance companies announced plans to suspend child-only insurance policies because of concerns over clarity of the new rules, as well as reservations that the provisions create an "unlevel playing field."

"Given the current uncertainty in the niche marketplace for child-only coverage, health plans have to make very difficult decisions about the types of new policies they will offer," says Robert Zirkelbach, press secretary for America's Health Insurance Plans, the national association representing health insurance providers.

"While well intended, the current regulation provides a powerful incentive for parents to wait to purchase coverage until after their children become sick," Zirkelbach says.

"I think it's very unfortunate that the insurance companies continue to make decisions on the backs of children and families that need their help," White House press secretary Robert Gibbs told reporters on Tuesday.

He said that even though child-only policies represent a small portion of the individual market, the goal is to make sure nobody falls through the cracks.

If you have a child-only policy, you can keep it, America's Health Insurance Plans says. If you were planning to purchase a child-only policy but have learned it is no longer offered by your insurance carrier, your child may qualify for SCHIP, the State Children's Health Insurance Program. Here is a state-by-state directory of SCHIP programs.

Adults who can't get insurance because of a pre-existing condition can look for a Pre-Existing Condition Insurance Plan (PCIP). Visit PCIP.gov to find out whether you are eligible and to learn more about what the monthly premiums are in your state.

No dropping people from coverage when they get sick

Insurance companies can no longer drop a customer when that person gets sick, nor can they look for errors on your insurance application and then not pay for a service when you get sick.

No lifetime limits on coverage

If you purchase a new health policy on or after Thursday, the Affordable Care Act prohibits that plan from placing a lifetime cap on the coverage you can receive for hospital stays and other expenses associated with your condition. Keep in mind that this does not include the use of annual dollar limits, which will be phased out over the next three years, and will be banned by 2014.

New plans must offer free preventive care

If you purchase a new health policy on or after Thursday, certain preventive screenings, immunizations and tests must be covered without your having to pay a copayment, coinsurance or meet your deductible when these services are delivered by a network provider. If you are already insured, these services should be offered to you during open enrollment, or when your individual policy renews. A full list of the preventive services covered under the Affordable Care Act can be found on Healthcare.gov.

Expanded ability to appeal decisions made by the health plan

Under current rules, when an insurer denies you coverage, you really didn't have many options.

About 44 states provide for some form of external appeal and the laws governing these processes vary greatly.

If you buy or join a new policy starting Thursday, you should be able to appeal to an independent third party. According to Jay Angoff, the director of the Office of Consumer Information and Insurance for Health and Human Services, your health insurance company is required to inform you of how to access the independent, objective reviewer.

Another resource if you have questions about whether the appeal process applies to you is your state insurance regulator. Also, later this fall, you will be able to find state-by-state lists of consumer assistance programs on Healthcare.gov.

Joshua Armstrong is now on a payment plan to repay the $10,000 hospital bill he amassed after his vehicle accident.

"It's been really tough," says Armstrong, "I didn't know an emergency room could be that expensive."

He and his mother are excited about this week's health care reform provisions and are planning to attend one of several nationwide educational events on Thursday being sponsored by the group Getting Covered to figure out what they need to do make sure Joshua will be insured in the future.

"We're looking forward to putting him back on," his mom says. "Debt is such a terrible way for a young person to start off."