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USA Health Care Coverage - goes into effect today
5 Replies
axxie - September 23

Here's a rundown of which new consumer protections go into effect today.

Coverage for children with pre-existing conditions

Insurance companies are no longer permitted to exclude from coverage pre-existing conditions in enrollees 18 and under. This provision, while wildly popular in the abstract, comes with a long list of caveats. There's nothing in the law that prevents insurers from charging as much as they want to cover the costs of paying for pre-existing conditions. While all group plans, such as those provided by employers, will fall under this new rule, individual policies that existed before March 23, 2010, aren't subject to it. Since new child-only plans will have to cover pre-existing conditions, some insurers have opted not to sell them at all. The government estimates 31,000 to 72,000 uninsured children could gain coverage because of this new rule and up to 90,000 who have insurance but have a pre-existing condition exclusion could get new coverage for their conditions — provided they can afford it.

Ban on lifetime limits and restrictions on annual limits

Insurers are no longer allowed to set a lifetime limit on benefits. This is particularly helpful to people with very expensive or long-term health problems. The government estimates that about 20,000 people in the U.S. hit their lifetime limits every year. The law also begins phasing out annual limits on coverage. Except for individual plans purchased before March 23, 2010, which may have "grandfathered status," all plans issued or renewed between today and Sept. 23, 2011, will not be able to set annual limits lower than $750,000. (The limit is raised each year until it is eliminated in 2014.) Not all plans have annual limits anyway and some are already higher than this, meaning the new rule will affect fewer than 2 million plans, according to federal estimates. For plans that currently have limits below $750,000 and will therefore have to make changes, the government predicts premiums will increase by percentages in the single digits.
(See the top 10 players in health care reform.)

Ban on rescissions

Insurance companies are no longer allowed to retroactively cancel policies just because people make inadvertent errors on their enrollment forms. Such action by insurers, while rare, is often egregious and a way for insurers to avoid paying for care when their customers become very ill. The new rule states that insurers can only rescind policies if enrollees are found to have committed fraud. The ban on unfair rescissions is, like coverage of pre-existing conditions in children, wildly popular but impactful for only a small number of people. The government estimates that currently there are about 10,700 rescissions every year.
(Comment on this story.)

Coverage for young adults

Insurance companies must allow parents to include children 25 or younger as dependents on their policies. Children 25 and under can join their parents' policies even if they are not listed as a dependent for tax purposes and even if they don't live with their parents. However, as with coverage for children with pre-existing conditions, there are a number of caveats that apply to this new rule. Some plans that existed before the Affordable Care Act was signed on March 23, 2010 — those which maintain "grandfathered status" will not be required to extend dependent coverage to these young adults if they can get their own insurance through work. Children 19-25 who have pre-existing conditions may face exclusion periods. Plus, about half the states already allow adult children to be included as dependents. Still, up to about 2.5 million young adults could gain new coverage.

Free preventive care

Insurers must cover preventive care without requiring enrollees to cough up co-pays or co-insurance. The rule only applies to preventive care delivered by practitioners in an insurer's network. Plans with "grandfathered status" do not have to abide by this new rule. Procedures, screenings and tests that are considered "preventive" will be determined by the U.S. Preventive Services Task Force, the Centers for Disease Control (for vaccines) and the Health Resources and Services Administration.

Other new rules

Regulations that kick in today also allow people more freedom to choose doctors within their insurers' networks and freedom to receive covered care in emergency rooms even if they are not pre-approved. Insurers also must follow a strict set of guidelines when handling claim appeals.


INPAINDAILYJC - September 23

I def need to pay attention to this insurance stuff. I have realized in the past couple of years, that most insurance companies think they are God and can tell us what they will and wont' cover. Sorry if this offends anyone but this is how I feel! God is the ONLY judge, yet the insurance company denied my AQUA therapy ONLY after racking up $2,000 worth of therapy!
Needless to say, I am not fond of insurance companies. And I have yet to find a rep that helps me. I know they are out there, I just don't seem to have any luck...

Does anyone else feel like they have been thrown through the ringer by insurance companies? I hope this new health care will help..

Thanks for the post. Very educational!


Marilyn - September 23

I think we're going to see a lot of nasty loop-holes. Some insurance companies are already being sneaky. Yes, they have to cover children; however, they don't have to offer SINGLE policies for children. Instead, they want to offer coverage as a tack on to a parent's. Caveat? They CAN DENY THE PARENT on a pre-existing!!!!

We cannot exclude hospitals and the medical field from fault. "They" throw in extra charges into hospital stays for items and service that were unpaid by another patient. They do this all the time, and sometimes it's obvious. A friend of my brother's had an MRI, and his insurance got billed $12,000 for it! I'd be willing to bet that they paid for THREE outstanding MRIs from other patients.

Obamacare doesn't know the half of it.


axxie - September 24

I have heard, that it won't be the best deal, so I'm wondering is this going to be the best he can do. I though, here's the guy, who talking about health care reform, I thought, he'd have a health care coverage that closely resembling European or Canadian more a social healthcare.

I have lived in many places, and found, that the States, do not provide for their children or elderlies.

I just can't believe that insurance companies have such manipulation, and such a strong hold on the Government.

It's all about money, and power, and I thought you guy's would finally get something worth while, I guess I'm wrong.

I may pay far more taxes, for health care or social programs but well worth it. At the end, I don't need to wonder, I know I have one of the best health coverage there is.


Nemesis3 - September 25

I am wondering if and when any changes will be made in the discrimination insurance companies inflict on the mentally ill. Is anyone else aware that only 50% of mental health care is covered by insurance companies? I doubt any changes will ever be made for these people. For those of you who are History buffs.....I look to see The Ship of Fools docking on our shores any day now!!


deadgamegrrl - September 25

Yep. Been living with that joy of coverage for 20 years. Of course, the last 14 I've been self-employed, and the only way I could afford coverage was with a 5K deductible. So far I pretty much pay EVERYTHING since I don't usually go over 5K in a year. The only benefit I get is cheaper drugs, a few free preventative screenings a year like mammograms, and the knowledge that I probably won;t lose my house if I get catastrophically ill.
Gotta love USA healthcare.



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