OpenPlacement Community > OpenPlacement Blog > Affordable Care Act for Dummies (Part 2 of 2)

Affordable Care Act for Dummies (Part 2 of 2) Christy Rakoczy

July 16th, 2013

Some probamacare-for-dummiesovisions of the Affordable Care Act have already begun to be implemented. Full implementation of the legislation will occur by 2014. At that time, 30 million Americans who were previously uninsured will have access to health care. The question is: How, specifically, are patients affected by the Affordable Care Act?

Some new ways that the Affordable Care Act will affect patients include:

No More Exclusions Based On Pre-existing Conditions

As many are aware, private insurance companies have been able to reject applications for insurance, or for treatment costs, of those who have a condition that existed prior to the application or date that the company extended coverage. This meant that those who had previously experienced heart disease or cancer, for example, could be rejected for coverage altogether, or could receive insurance benefits but with exclusion of payment for any treatment related to the pre-existing condition. Under the Affordable Care Act, insurers will no longer be able to exclude or reduce benefits for those reasons.

Coverage Cannot Be Dropped

In addition to insurers previously being able to reject applications or reduce benefits based on pre-existing conditions, in some states it has remained legal to drop patients from coverage upon development of illness. The Affordable Care Act prevents this practice from happening by banning insurers from withdrawing coverage.

Lifetime and Annual Benefits Are Eliminated

No longer can insurers offering policies to groups limit benefits on an annual or lifetime basis for “essential” benefits. The legislation is, however, unclear on what constitutes “essential,” so the breadth of this change is yet to be known.

Dependent Coverage Is Lengthened

Parents may now cover their children on their insurance policy until the age of 26. This drastically increases the amount of time that children can remain on a policy and dramatically improves the possibility of those in their young twenties, who may not have access to the best health insurance, will have adequate care.

Improvements in Insurance Company Spending

To improve care, reduce cost, and prevent insurers from benefitting from high insurance costs, the Affordable Care Act requires that every insurance company spends 80 or more cents of every dollar spent on premiums on members’ healthcare. If an insurer fails to meet this requirement, a refund of the difference must be paid to the insured.

Preventative Care

New plans are required to pay the cost, in full, of a variety of preventative services. This means that patients can better prevent health conditions and injuries in a proactive way, rather than being reactive once a condition has already developed.

Limits Of Out Of Pocket Expenses

Limits on what patients are required to spend out of their own pockets will be limited by the Affordable Care Act. These limits will be income-based.

Comparison of Plans Is Easier

At www.healthcare.gov, any American can compare healthcare plans to find the plans that meet their needs. Whether locating a plan that ensures care from a specific provider, or looking for the lowest cost options, this website helps all patients to find the care that is right for them.

There are some changes as a result of the Affordable Care Act that some may consider to not be as positive. Some of these include a 10% tax on indoor tanning services, penalties for those who chose not to be insured and increased Medicare payroll tax for those earners in excess of $200,000 per year (or $250,000 per couple). However, the majority of Americans, particularly those who are currently uninsured, should see positive changes in their care and accessibility to services as these changes are implemented.

Comments

  1. Rebecca Evans-Slone July 17, 2013

    Great! Can I get a copy of Part 1?? Thank you!

    Reply
  2. Christy Rakoczy July 17, 2013

    Rebecca – Thanks for reading and the feedback! I posted Part 1 a few weeks back and it can be read by going to the following link:

    https://www.openplacement.com/community/blog/affordable-care-act-for-dummies-part-1-of-2/

    Reply
  3. Pandora Papini July 17, 2013

    Thank you for the updated information on the Affordable Care Act. I’ll be taking my exam for CMSA in 12/2013.

    Reply

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