The much debated Patient Protection and Affordable Care Act and Health Care and Education Affordability Reconciliation Bills have attracted much attention. Here is a brief overview of some key points of the legislation:
For Small Businesses
Tax credits to small businesses that will make employee insurance coverage more affordable. Tax credits of up to 35% of premiums will be available effective beginning calendar year 2010. Starting in 2014, these tax credits will cover up to 50% of premiums.
For Seniors
It will begin to close the Medicare “Donut Hole.” It provides a $250 rebate to people on Medicare who reach the prescription limit in 2010. In 2011, they will be able to receive up to a 50% discount on brand-name medicines in the coverage gap. The gap will be eliminated by 2020. (The donut hole is a gap between $2,700 and $6,154 where there is no Medicare cost coverage)
It eliminates co-payments for preventative services and exempts preventive services from deductibles under the Medicare program starting January 1, 2011.
For Privately Insured
Makes it illegal for new health plans to deny coverage to children with pre-existing conditions.
(Effective: 8/27/2010)
Provides immediate access to insurance for people who are uninsured because of a pre-existing condition. This will be replaced in 2014 when the Exchanges begin.
Health plans will no longer be allowed to drop people from coverage when they get sick.
(Effective: 8/27/2010)
Eliminates lifetime limits or caps on the amount of coverage you can receive. (Effective: 8/27/2010)
Requires new private plans to cover preventive services with no co-payments and makes them exempt from deductibles.
(Effective: 8/27/2010)
Consumers will have access to an internal and external appeals process. (Effective: 8/27/2010)
Higher percentage of premiums will be spent on health coverage. Plans in the individual and small group market must spend 80% of premiums on medical services and large groups to spend 85%. If they fail to do this then they must give rebates to policyholders. (Effective 1/1/2011)
Young people are covered under their parents plan until their 26th birthday. (At their parents’ choice)
General Reforms
Increased funding for community health centers to allow them to increase the number of patients they can serve over the next five years.
New investments in training programs to increase the number of primary care doctors, nurses, and public health professionals.