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Healthcare reform: What it means for you

When President Barack Obama signed the Affordable Care Act of 2010 into law last year, Americans were on the cusp of getting better control of their healthcare coverage. Many rights granted by this law have already taken effect; others won’t become effective until 2014. But the gradual changes that are happening mean that more people can get—and keep—affordable healthcare coverage. How will it affect you and your family? For more information, visit or contact your health insurance company.

If you have kids, their rights to healthcare coverage have been expanded.

  • In fall 2010, insurance companies lost their right to discontinue coverage to children with pre-existing conditions, giving their parents one less thing to worry about. (Previously, healthcare plans could deny coverage to sick kids.)
  • Dependent coverage was also extended for children until they reach their 26th birthdays, except in cases where individual healthcare plans were grandfathered in, meaning that someone’s pre-existing coverage would stay the same. (Previously, many plans stopped coverage once a child turned 19 or was no longer a student.) This means that young adults who are job hunting can get health coverage through mom and dad.

If you’re a senior citizen, you may start paying less out-of-pocket for medication.

  • Beginning in June 2010, the roughly 8 million senior citizens who had been experiencing a gap in prescription drug coverage by Medicare Part D—the so-called “doughnut hole”—received checks for $250 to help make their medications more affordable for the rest of the calendar year.
  • In 2011, pricier brand-name drugs in the doughnut hole are being discounted by 50 percent by manufacturers. By 2020, the doughnut-hole gap in prescription drug coverage will be eliminated.

If you have a serious illness or major injury, you’ll have more of a safety net.

  • Last year, insurance companies lost the right to cancel coverage for policyholders who developed serious illnesses if their paperwork had unintentional errors. This will give those who have been recently diagnosed with a health issue time to get second opinions and treatments.
  • In 2010, lifetime caps set by insurance companies were eliminated from policies issued or renewed after Sept. 23, 2010. Previously, insurance companies could set a lifetime dollar limit for individuals; when someone reached that cap, the insurance plan would no longer provide benefits.
  • In 2010, the Affordable Care Act also began phasing out insurance companies’ rights to impose annual limits, and they’ll be completely eliminated by 2014.

If you don’t have health insurance, help is on the way.

  • In the summer of 2010, people who were previously unable to get insurance coverage due to illnesses or pre-existing conditions were able to begin enrolling in a Pre-existing Condition Insurance Plan. The program will remain in effect until 2014, when insurance companies will no longer be able to ban people from health plans due to pre-existing conditions.
  • In 2014, the roughly 30 million Americans without health insurance will be able to get affordable coverage through state-run health insurance exchanges set up specifically for them.

Health premiums may continue to rise for the foreseeable future, as they’ve done in the recent past, but changes that have taken place or are coming soon should make healthcare affordable for everyone who needs it.

If you want more choices and better value from your healthcare plan, some of your wishes have been granted.

  • In January, health insurance companies became obligated to make your healthcare money work more efficiently for you. The Affordable Care Act required them to begin spending at least 80 percent (for individual and small group insurers) or 85 percent (for large group insurers) of a policyholder’s premium dollars directly on medical care and efforts to improve the quality of care. If they fall short, insurance companies must provide policyholders with rebate checks. The intention is to limit overhead and excessive salaries or bonuses to insurance company executives.
  • If you’ve been assigned a primary care physician you don’t like, you shouldn’t have to continue seeing him or her. Last September, the law gave policyholders the right to choose their own participating primary care doctors and visit an Ob/Gyn without a referral, except for health plans that were grandfathered in. (Previously, many plans required that women get referrals from their primary care doctors to see an Ob/Gyn, even for a follow-up appointment.)
  • In fall 2010, the Affordable Care Act gave policyholders the right to seek treatment at out-of-network emergency rooms without getting prior approval from the insurance company, except for health plans that were grandfathered in. This will be particularly helpful for vacationers who get injured while visiting another state that may not have in-network facilities or people in car accidents who are brought to the hospital unconscious.