8 health law changes that just began — with 7 caveats

Kaiser Health NewsSeptember 23, 2010 

WASHINGTON — If you've tuned out the new health care law, you might want to tune back in. A set of new consumer protections went into effect Thursday, the six-month anniversary of the law.

Here's a guide to some of the changes, and some caveats. Keep in mind that how they affect you will depend on what kind of insurance you have.

  • Insurers must allow parents to keep an adult child up to age 26 on their health plan, and those young adults can't be charged more than any other dependent. Some insurers began this policy early, during the summer.

    BUT: This doesn't begin until your new plan year begins. For many, that will be Jan. 1. Also, if your child has an offer of coverage from an employer, he/she might not be able to be on your plan.

  • Insurers can't charge co-payments or deductibles for preventive services such as breast cancer screening and cholesterol tests.

    BUT: "Grandfathered" plans — those that don't make major changes from the previous plan year — don't have to follow this requirement.

  • Insurers must cover children up to age 19 with pre-existing medical conditions. New individual plans and all group plans — such as those you get at work — can't refuse to cover a child.

    BUT: "Grandfathered" individual health plans can refuse to cover a child.

  • Insurers can't cancel coverage once you get sick, a practice known as rescission.

    BUT: If you committed outright fraud and hid something, your insurer can refuse to pay.

  • Consumers get direct access to physicians: You — not your insurance company — decide which primary physician, gynecologist, obstetrician and pediatrician you see among your plan's list of approved providers.

    BUT: The usual obstacles remain, such as whether the doctor is taking new patients or has an appointment available.

  • No additional payments can be required for out-of-network emergency room care: Insurers can't require higher co-pays or deductibles if you have a medical emergency and seek treatment at an emergency room that's not in your health insurance plan.

    BUT: Once again, "grandfathered" plans are exempted.

  • Annual limits on coverage will be going away.

    BUT: First they'll increase to $750,000 for all employer plans and new individual plans, rising to $1.25 million after Sept. 23, 2011, and then to $2 million the following September.

  • No lifetime limits: All plans, even "grandfathered" plans, will be prohibited from setting dollar limits on lifetime coverage.

    No "but" on this one.

While the following provisions have been around for a while, they're worth noting, too:

  • High-risk pools: Designed to help people who've been uninsured for six months get coverage. Each state has its own pool.
  • Help to companies in paying for early retirees: More than 2,000 employers and unions have applied for government grants to cover up to 80 percent of retirees' medical costs between $15,000 and $90,000 until they can qualify for Medicare coverage.
  • Small business tax credits: 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 of up to 35 percent of the cost of premiums. That credit will rise to 50 percent in 2014. To qualify, businesses must cover at least 50 percent of the cost of workers' insurance.

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