Some of the new health care law provisions kick in

from the AP: http://www.google.com/hostednews/ap/article/ALeqM5g8w9MBW0oMvGXF-1tmQSZzXD3rVgD9ID4AFG0

Q: What are some of the new benefits?

A: Free preventive care, for one. Some people will no longer have to pay copays, coinsurance or meet their deductibles for preventive care that's backed up by the best scientific evidence. That includes flu vaccines, mammograms and even diet counseling for adults at-risk of chronic disease . . .

___ If you go to an emergency room outside your plan's network, you won't get charged extra. Patients will be able to designate a pediatrician or an ob-gyn as their primary care doctor, avoiding the need for referrals that are required by some plans . . .

___ Millions of Americans have insurance that sets a cap on what their insurance will pay to cover their medical costs over a lifetime. The caps have left very sick patients with medical bills topping $1 million or $2 million high and dry. These lifetime limits will be eliminated for plans issued or renewed on or after Sept. 23 . . .

___ Plans issued or renewed on or after Sept. 23 can't have annual limits lower than $750,000. Annual limits will be eliminated entirely by 2014 . . .

___ Insurers can no longer deny coverage to children with pre-existing conditions. Also, parents can keep their adult children on their health plans until age 26 . . .

___ The law bars insurers from canceling policies retroactively when a person gets very sick and runs up high bills. Insurers still will be able to rescind policies in cases of fraud and intentional misrepresentation. But they can't cut you off when you need coverage most for a capricious reason . . .

read more: http://www.google.com/hostednews/ap/article/ALeqM5g8w9MBW0oMvGXF-1tmQSZzXD3rVgD9ID4AFG0


Fact Sheet: The Six Month Anniversary of the Affordable Care Act

On March 23, 2010 President Obama signed the Affordable Care Act into law. The landmark new law will put into place comprehensive health insurance reforms that will hold insurance companies accountable, lower health care costs, guarantee more health care choices, and enhance the quality of health care for all Americans.

On September 22, President Obama will mark the upcoming six month anniversary of the law’s enactment by meeting with Americans from across the country who will benefit from the new law and celebrate the implementation of the Patient’s Bill of Rights that was included in the Affordable Care Act.
Additionally, the Administration will release state-by-state reports detailing the impact of the Affordable Care Act and a revamped website – www.WhiteHouse.gov/HealthReform -- which includes information on the impact of the law and stories from Americans in all 50 states who are benefiting from the Affordable Care Act. Some of the participants whose stories are highlighted on the new website will include:


* Dawn Josephson, Dawn Josephson from Jacksonville, FL, who can now live with the security of knowing that her new insurance policy can’t exclude coverage for young her son who recently had eye surgery.
* Gail M. O’Brien from Keene, NH who was previously uninsured and diagnosed with high grade non-Hodgkin's lymphoma. Gail is enrolled in the new Pre-Existing Condition Insurance Plan that will pay for her treatments and is responding very well.


Details on the Patient’s Bill of Rights and examples of how the Administration has already delivered benefits of the Affordable Care Act to the American people are included below.


A New Patient’s Bill of Rights

On September 23, critical new consumer protections in the new law – a Patient’s Bill of Rights -- begin to take effect. The Patient’s Bill of Rights puts an end to some of the worst insurance company abuses, and puts consumers, not insurance companies, in control of their health care. These new protections include:

Ban on Discriminating Against Kids with Pre-Existing Conditions:
Before reform, tens of the thousands of families had been denied insurance each year for their children because of an illness or condition. Starting September 23rd, plans cannot discriminate against kids with pre-existing conditions. In 2014, no one seeking coverage can be discriminated against because of a preexisting condition. Up to 72,000 uninsured children are expected to gain coverage by banning insurers from refusing them coverage due to a pre-existing condition. Coverage for up to 90,000 children will no longer exclude benefits because of a pre-existing condition.

Ban on Insurance Companies Dropping Coverage:
Before reform, insurance companies could cancel your coverage when you got sick and needed it most because of a simple mistake on your application. Starting September 23rd, insurance companies are banned from cutting off your coverage due to an unintentional mistake on your application. Approximately 10,700 people’s coverage, whose coverage is dropped each year because they get sick or make a technical mistake on their application, will be protected under the new law.

Ban on Insurance Companies Limiting Coverage:
Before reform, cancer patients and individuals suffering from other serious and chronic diseases were often forced to limit or go without treatment because of an insurer’s lifetime limit on their coverage. Starting September 23rd, insurance companies can no longer put a lifetime limit on the amount of coverage they provide, so families can live with the security of knowing that their coverage will be there when they need it most. Up to 20,400 people who typically hit their lifetime limits on the dollar amount that can be spent on coverage, along with the nearly 102 million enrollees who have policies with lifetime limits, will no longer have to worry about hitting their benefits caps. The use of annual dollar limits will be restricted, and in 2014 will be banned completely. By 2013, up to 3,500 people will gain coverage as a result of the ban on annual limits that insurers impose on nearly 18 million people today.

Ban on Insurance Companies Limiting Choice of Doctors:
Before reform, insurance companies could decide which doctor you could go to. Starting September 23rd, if you purchase or join a new plan you have the right to choose your own doctor in your insurer network. Up to 88 million people will benefit from the provision that protects primary care provider choice by 2013.

Ban on Insurance Companies Restricting Emergency Room Care:
Before reform, insurance companies could limit which emergency room you could go to or charge you more if you went out of network. Starting September 23rd, if you purchase or join a new plan, those plans are banned from charging more for emergency services obtained out of network. Up to 88 million people will benefit from this provision.

Guarantee You a Right to Appeal:
Before reform, when insurers denied you coverage or restricted your treatment, you were left with few options to appeal. Starting September 23rd, if you purchase or join a new policy, you will be guaranteed the right to appeal insurance company decisions to an independent third party. Up to 88 million people will benefit from the new appeals process provisions by 2013.

Covering Young Adults on Parent’s Plan:
Starting September 23rd, young adults will be allowed to remain on their parent’s plan until their 26th birthday, unless they are offered coverage at work. Up to 2.4 million young adults, up to 1.8 million who are uninsured and nearly 600,000 who purchase coverage in the individual market, could gain coverage through their parents.

Covering Preventive Care With No Cost:
Starting September 23rd, if you join or purchase a new plan, you will receive recommended preventive care with no out-of-pocket cost. Services like mammograms, colonoscopies, immunizations, pre-natal and new baby care will be covered and insurance companies will be prohibited from charging deductibles, co-payments or co-insurance. Up to 88 million people will have access to preventive care with no out of pocket costs.


Six Months of Progress

In addition to implementing the Patient’s Bill of Rights, the Obama Administration has worked to deliver other benefits of reform to the American people. In the last six months, the Administration has:

Fought Waste, Fraud and Abuse: The Affordable Care Act includes robust new tools that will help fight fraud and protect taxpayer dollars. Using these new tools, HHS Secretary Kathleen Sebelius has pledged to cut Medicare’s error rate (the percentage of claims paid inappropriately) in half by 2012. A proposed regulation that implements the first round of Affordable Care Act policies to combat Medicare and Medicaid fraud was issued on September 17.

Helped Fight Premium Increases: The Affordable Care Act also includes critical new resources and authorities to crack down on unjustified rate hikes. Today, 46 states are using resources under the new reform law to pass or strengthen premium rate review laws which will have a significant impact on keeping year-to-year increases in premiums low. In a number of states (California, Massachusetts, Maine) regulators have already reviewed and rejected these proposed increases. We expect this pattern to continue. The Administration has also been working on rules that require insurance companies to spend at least 80 percent of premium dollars on health care instead of overhead, salaries or administrative expenses, in 2011. If they fail to do so, they will be required to provide rebates to consumers.

Offered Support for Small Businesses: Under the Affordable Care Act, up to 4 million small businesses nationwide could qualify for a small business tax credit this year, which will provide a total of $40 billion in relief for small firms over the next 10 years. Small businesses have been notified of these tax credits and can make plans knowing the credits will help bring down their health care costs.

Helped Make Prescription Drugs More Affordable: More than 1 million seniors who have fallen into the prescription drug coverage gap known as the donut hole have received $250 rebate checks. The checks are the first step toward closing the donut hole in 2020.

Launched a New Website to Make it Easier to Find Coverage: On July 1, the Administration launched www.HealthCare.gov. www.Healthcare.gov is a new, easy to use website that helps consumers take control of their health care and make the choices that are right for them by putting the power of information at their fingertips. The website is the first of its kind to bring information and links to health insurance plans and other coverage options to one place, making it easier for consumers to learn about their insurance options. The site includes extensive, easy to understand information about patients’ rights, how to navigate the current insurance market, and how the Affordable Care Act will help them. A Spanish language version – www.CuidadodeSalud.gov – was launched on September 8, and additional pricing information will be added on October 1.

Started Covering Individuals With Pre-Existing Conditions: On July 1, the Administration announced the establishment of the Pre-Existing Condition Insurance Program to provide coverage for eligible Americans who have been uninsured for six months because of a pre-existing condition. Coverage started in 47 states by August, and will be provided in all states by the end of September.

Provided Employers Support to Cover Early Retirees: On August 31, the Administration announced that over 2,000 employers and unions across all fifty states had been approved to receive help to pay for their early retirees’ health care through the Early Retiree Reinsurance Program. This program will help many older Americans, who are not yet eligible for Medicare, continue to have quality affordable coverage through their employer.

read: http://www.whitehouse.gov/the-press-office/2010/09/22/fact-sheet-six-month-anniversary-affordable-care-act

:thumbsup:

indicating follow up is needed? I know from personal experience it can cost several thousand dollars to find out that spot on the film is benign. Fortunately I had good insurance at the time. I did have a $10 copay for the screening mammogram and the follow up cost about $800 out of pocket. For nearly two years I've had insurance with "free" screenings - but if the same problem came up now it would run me over $2,000 out of pocket.

BTW preventative/screening tests aren't free they're covered in the cost of the premium. And even before the insurance bill passed even lousy insurance policies would cover them - because the insurance companies know people won't have the tests if they're worried about paying for any follow up.

...recommended against routine mammograms for women under 50 w/o other risk factors. They are very good at finding benign lumps, and not very good at finding cancers. The intervention rate for breast cancer has soared, but it hasn't actually lowered the death rate at all.

It isn't always a lump.

The cells were benign but considered "atypical". Which does not necessarily mean I'm at higher risk (because no one really knows which atypical cells are precancerous) but does make the insurance companies look at me cross-eyed and were enough of a concern after the needle biopsy that a more complete surgical biopsy was called for.

Though, despite finding more benign lumps under 50, breast cancer in premenopausal women tends to be more aggressive. Personally, I'd rather have the benign lump looked at rather than not find the malignant one until it's spread. As to whether or not the death rate has dropped, it does depend how you read the stats & how far you go back with them.

$400 a month laying around to insure the 25 year old kid, what happens? It's fine to "have access," but you also need to "have money." A whole lot of people are in the same fix they were a year ago: coverage might be available, but the price tag is out of reach. That's why we're up to 50 million uninsured and climbing.

. . . yet, many folks are advantaged by some of the emerging provisions of this legislation.

But that's how it is in the "greatest nation on earth."