While much of the federal Patient Protection and Affordable Care Act (aka health care reform) does not fully take effect until 2014, some key provisions affecting health insurance apply to health plan years beginning on or after tomorrow, September 23, six months from the date the president signed the law. The changes include:
- Young adults can stay on their parents' plans until age 26 unless the parents have a group health plan and the young adult has the option to purchase a plan where he works.
- Plans created since March 23, 2010 must cover certain preventive care procedures such as cancer screenings, mammograms and colonoscopies and may not charge deductibles, co-payments or coinsurance. The plan may charge a fee if the patient uses an out-of-network provider. Plans created before March 23 are not subject to this requirement.
- Insurers may not rescind coverage after an insured gets sick. This was a larger issue in states, such as California, that have a large individual health policy market; New York's individual market is comparatively small, so it has not been a major issue here.
- New procedures for patients to appeal insurers' claims decisions and an external review process apply to plans created after March 23.
- Insurers may no longer apply lifetime dollar limits on "essential" benefits, such as in-patient care at hospitals, and new restrictions on annual limits apply.
- Insurers may not deny coverage for children under age 19 who have pre-existing conditions.
These changes come on top of those implemented earlier this year, including small business health insurance tax credits, the closure of the so-called "donut hole" for Medicare prescription drug beneficiaries, funding to state governments for expanded Medicaid coverage, new screening procedures to reduce fraud in public health programs, an early retiree reinsurance program, and coverage pools for uninsured persons with pre-existing conditions.
This law remains controversial six months after its enactment, particular the requirement beginning in 2014 that most individuals purchase health coverage or pay a tax penalty. That requirement is more than three years away. What do you think of the changes that take effect this month or that have already taken effect? Are they desirable? Too expensive? Too intrusive? Long overdue? Do they not go far enough? Leave your thoughts in the comments.