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Health reform begins: What changes mean to you
Many features, such as no more lifetime insurance caps, kick in by Sept. 23 Advertisement | ad info
.By Mary Agnes Carey
updated 9/15/2010 8:32:25 AM ET
Share Print Font: +-By Sept. 23, the six month anniversary of the enactment of the health overhaul, many of the law’s provisions will be in effect. Most consumers, however, won’t see any changes until after Jan. 1 when their new health plan year begins.
In the meantime, employees will be getting ready for fall’s “open enrollment” period, when they pick their health coverage for the following year. In addition, people who buy their own health insurance will be researching their options. And Medicare beneficiaries will be able to change their coverage later this year, if they want to. Here’s a look at how the law affects people who get their coverage at work, buy their own health insurance or are enrolled in Medicare.
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..Q: I get my coverage through work and the “open enrollment” period for next year is approaching. I’d like to keep my current health plan. Will it be affected by the new law?
A: Your plan will feature some new consumer protections. For example, your plan won’t be able to set a lifetime limit on coverage. And if you have an adult child up to age 26 who can’t get health insurance at a job, you’ll be able to keep him or her on your health plan.
These changes kick in for plan years beginning on or after Sept. 23.
If your employer makes significant changes — like cutting benefits or raising your out-of-pocket costs beyond a specific amount — the plan is considered a new plan (rather than an existing “grandfathered” one) and must include a wider set of consumer protections.
Q: Like what?
.Patients will get, for example, certain preventive services such as breast cancer screenings and cholesterol tests without paying deductibles or co-payments. In addition, they’ll be able to see obstetricians and pediatricians without getting prior authorizations. Recommended immunizations also must be provided at no cost.
Q; What if my employer offers a new plan and I want to switch to that?
A: In that case, your coverage would include the wider set of protections.
..Q: Will my health insurance cost less?
A: Probably not. Health insurance premiums have been increasing steadily over the last decade and that trend is continuing. According to a new report from the Kaiser Family Foundation and the Health Research & Educational Trust, workers nationwide on average are paying 14 percent, or $482, more for family health insurance coverage in 2010 than in 2009. Employers, struggling with the recession, aren’t increasing their share. Instead, they’re shifting more costs onto employees, according to the survey. (KHN is a program of the foundation).
A recent study by the National Business Group on Health found almost two-thirds of employers planned to ask employees to contribute more toward their premiums.
Q: I’m a small business owner. Do I have to offer coverage to my workers this fall? And if I do, will the government help me pay for it?
A: No business owner — small or large — is required to offer coverage. But small businesses with 25 or fewer full-time employees who earn an average yearly salary of $50,000 or less will qualify for a tax credit up to 35 percent of the cost of premiums. The credit increases to 50 percent in 2014 for most small employers. To qualify for the credits, businesses must cover at least 50 percent of the cost of workers’ insurance.
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Starting in 2014, businesses with 50 or more employees that don’t provide health care coverage and have at least one full-time worker who receives subsidized coverage in the health insurance exchanges will have to pay a fee of up to $2,000 per full-time employee. (The firm’s first 30 workers would be excluded from the fee.) Businesses with 50 or fewer workers would be exempt from the requirement.
Q: I buy my own health insurance. How will the health law affect my coverage?
A: For policy years starting after Sept. 23, all health insurance policies in the individual market will be barred from cancelling coverage once you get sick — a practice known as “rescission” — unless you committed fraud when applying for coverage. Insurers will be prohibited from setting lifetime limits on your coverage. The plans must allow you to keep an adult child up to age 26 on your health plan.