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Federal law mandates "zero cost" contraception, but don't put away your checkbook just yet.
Learn what changes have been implemented and what's still to come under the Affordable Care Act.
The way we buy health insurance is going to be radically transformed by 2014.
Has health care reform affected you? Discover everything you need to know here
Last updated Oct. 15, 2010
There are a lot of promises within the health care reform law, but changes may not actually affect you for years, especially if you buy group coverage through your workplace. Click on the information buttons below to find more details.
Medicare rebate checks. Those on Medicare’s prescription drug plan whose initial benefits run out will receive a one-time $250 rebate designed to help cover the so-called "donut hole" gap in coverage. More discounts and subsidies will be phased in until the doughnut hole is eliminated by 2020.
Pre-existing Condition Insurance Plans will last until 2014. These will provide immediate access to coverage for people who have no insurance now due to health problems. The out-of-pocket premium will be capped at $5,950 for individuals and $11,900 for families.
The Early Retiree Reinsurance Program provides funds to help employers extend group health insurance to workers who retire between age 55 to 65. The program is scheduled to stop in 2014, when early retirees can take advantage of insurance exchanges.
Community health centers will be funded.
Healthcare.gov was created to give consumers a place to find health insurance comparison options and tools to pick appropriate coverage.
Now (began Sept. 23, 2010):
Free preventive services: Health plans years beginning on or after Sept. 23 have to cover a number of preventive services like mammograms and colonoscopies for free. No deductible, co-pay or coinsurance.
No health insurance rescissions: Health insurance companies cannot drop you from your individual health insurance plan if you get sick.
Children’s coverage: New individual plans and existing group plans cannot deny coverage to children with pre-existing conditions.
No lifetime caps, annual caps phased out: Insurers cannot place lifetime caps on coverage. Annual limits will be phased out.
Stay on parent’s health plan until age 26: Adult children will be eligible for coverage as dependents on their parents' policies until they are 26, unless they have access to health insurance through a job.
Appeal health insurance claim denials: New plans must include a way to appeal coverage determinations or claims. An external review process must also be established.
- Medical loss ratio: Individual health insurance plans and small-group insurance plans must spend 80 percent of premiums on medical services, while large group plans have to spend at least 85 percent. If health insurance companies don’t meet these levels, they will have to give rebates to policyholders. This law goes into effect Jan. 1, 2011.
- Discount on prescriptions for seniors: On Jan. 1, 2011, seniors who fall into that "donut hole" gap will receive a 50 percent discount on Medicare Part D covered brand-name prescription drugs.
- Free preventive care from Medicare, like annual wellness visits with no co-payments, begins Jan. 1.
- The Community First Choice Option will give states the option of treating disabled persons using Medicaid at home or through community-based services, instead of just at nursing homes. This begins Oct. 1, 2011.
- The Community Care Transitions Program will coordinate care for Medicare beneficiaries who have been released from the hospital, in order to reduce the number of re-admissions.
- The Independent Payment Advisory Board will begin operating on Oct. 1, 2011, and will look for ways to cut wasteful spending out of the Medicare system.
Accountable Care Organizations will use incentives to encourage doctors to better coordinate patient care and reduce illness and disease.
CLASS, a long-term insurance program, will be created on Oct. 1, 2012, to use voluntary payroll deductions to provide cash benefits for people who later require long-term care services.
- Electronic medical records: Health plans must begin implementing ways to exchange confidential medical information.
- More taxes: Families who make $250,000 or more ($200,000 or more for singles) will pay more in Medicare payroll taxes. Unearned income on this group will also be taxed.
- Flexible spending accounts: Those who utilize flexible spending accounts will be limited to $2,500 in contributions. This number will be adjusted yearly for the cost of living, and these plans will no longer allow reimbursement for over-the-counter medications. The threshold for deducting out-of-pocket medical expenses on your taxes will rise from 7.5 percent of income to 10 percent. (People over age 65 will remain at the 7.5 percent deduction threshold through 2016.)
- Medicaid programs will receive new funding to cover preventive services, meaning more access for more patients.
- The Children’s Health Insurance Program (CHIP) will receive funding for two more years on Oct. 1, 2013.
Individual mandate: Most individuals will be required to buy health insurance, and most employers will have to provide coverage. Both groups will face penalties for non-compliance. American Indians, those with religious objections and those who would face a financial hardship are exempt. If you would end up paying more than 8 percent of your income for health insurance, you won't have to pay penalties for not buying coverage.
Cannot deny coverage for pre-existing conditions: As of Jan. 1, 2014, health insurers may no longer deny coverage or refuse to renew coverage to adults with pre-existing conditions. They also may not charge higher premiums based on gender or pre-existing conditions.
Health insurance exchanges: If your employer doesn’t offer health insurance, you will have the option to buy affordable health insurance through state-run insurance marketplaces called exchanges. If you have coverage through your employer but your policy covers less than 60 percent of costs, or you pay more than 9.5 percent of your income to get that coverage, you can buy subsidized coverage. If you still can’t afford the insurance coverage offered by your employer, you can take the funds they would have contributed to the group plan and use them to buy potentially cheap health insurance from the exchange.
- No annual limits: Annual limits on coverage are no longer allowed for new plans and existing group plans.
- Health insurance subsidies: Families with income up to 400 percent of the federal poverty level (about $43,000 for an individual or $88,000 for a family of four) will earn subsidies to buy health insurance.
- Medicaid expansion: Families who earn less than 133 percent of the poverty level (about $14,000 for an individual and $29,000 for a family of four) can enroll in Medicaid.
- Insurance companies will be banned from charging higher premiums because of a person's sex or health status.
- Small-group health plan deductibles will be limited to $2,000 for individuals and $4,000 for families. Contributions can be offered to offset any amounts above these amounts.
- Waiting periods for health insurance coverage will be capped at 90 days.
- The Medicare Part D out-of-pocket maximum that enrollees pay for catastrophic coverage will be lowered.
- Clinical trials: Health insurance companies many not drop or limit coverage for patients who choose to participate in a clinical trial for treatment for a life-threatening disease.
- Doctors’ pay will be tied to quality of care rather than volume of patients.
- A 40 percent excise tax on high-end policies (that is, health insurance plans with annual premiums of $10,200 for individuals and $27,500 or more for families) will be imposed. It is unclear who will have to absorb this cost: consumers or employers.
Additional Health Care Reform Articles
- Watch your mail for a possible health insurance rebate
You may be entitled to a refund if your insurer didn't spend enough last year on medical care.
- Are women less healthy than men?
A government report says women take more physical and mental health days off than men.
- Bargain-basement health insurance rates available in some states
The government has slashed rates for its Pre-Existing Condition Insurance Plans.
- Ladies: More medical care without health insurance co-pays coming in 2012
New health plans can't have co-pays or deductibles for birth control and other preventive health services for women next year.
- Think you're locked out of affordable health insurance? Try PCIPs
You may qualify for a safety-net program for those who don’t have a health plan.
- Health care reform is an unreliable weight loss counselor
The government is dishing out new rules to help us slim down.
- Large companies remain confident about offering health insurance
Employers don't plan to dump workers into health insurance exchanges.
- Will you lose your employer-sponsored health insurance in 2014?
Some employers are planning to ditch group health plans in a few years and push you into a health insurance exchange. What are the consequences?
- Did AARP sell out seniors?
Three Republican congressmen ask the IRS to investigate AARP's tax-exempt status. Democrats say it's an effort to punish the group for supporting health reform.
- Battle of the health insurance rate reviews
What defines an "excessive increase" in health insurance premiums, and who's going to do something about it?
- Battlegrounds abundant for health care reform repeal
Opponents focus on political, legal and regulatory strategies to try to send health care reform packing.
- Medical loss ratios will control health insurance company profits
Starting this year, health insurance companies must spend 80 to 85 cents on health care for every dollar they collect in premiums.
- New rules on HSAs may surprise you at the pharmacy
Without a prescription or a letter from your doctor, most over-the-counter drugs will no longer be reimbursable through HSAs, FSAs or other reimbursement accounts.
- How health insurance exchanges will work
People who don't receive health insurance coverage through a large employer will have a new range of options when states start operating health insurance exchanges.
- Slow enrollment for high-risk health insurance pools
In many states, the new high-risk health insurance pools for patients with pre-existing conditions haven't attracted as many people as expected.
- Employers blame health insurance increases on health care reform
Employers large and small are braced for health insurance rate hikes – and pointing the accusing finger at health care reform laws.
- Health insurance pools for people with pre-existing conditions
In some states, you may be able to choose which high-risk health insurance plan is best for you -- the older state high-risk insurance pool…
- Why health insurance companies are pushing for "medical homes"
A growing number of primary care practices are becoming "patient-centered medical homes." So what does that mean for you?
- Health care reform: Accountable care organizations
Starting in 2012, groups of doctors that work together to coordinate care for patients can share in some of the savings from improving care and…
- Health care reform: Fighting health insurance claim denials
You have a right to appeal a health insurance claim denial.