September 7, 2010

Has anyone noticed that the Affordable Care Act is already here?

I tried hard to follow the long battle in the U.S. Congress over health-care reform, and eventually gave it up:  far too complicated. The only thing clear to me was that Big Pharma and the health insurance industry were spending zillions of dollars to discredit reforms -  and getting their money's worth.

But when the smoke of battle finally cleared we had the Affordable Care Act, passed in Congress this March 2010, and signed into law by President Obama. It bars health plans from denying coverage to people who already have an illness, dropping the coverage of people who become sick, charging higher premiums because of health issues. Sounds good in theory; in practice...well, we shall see.

And we'll see sooner than I had imagined: In just two weeks, on September 23, the first consumer protection rules go into effect. I wonder if they will affect any of my American contacts reading this?

Effective Sept. 23:

- No discrimination against children with pre-existing conditions.  The new law includes rules to prevent insurance companies from denying coverage for children with health problems who might run up a lot of doctors' bills.

- Prohibits insurance companies from dropping coverage.  In the past, insurance companies could search for an error on a customer's application or other technical mistake and use it as a pretext to stop covering the person when he or she got sick. The new law makes this illegal and after media reports cited incidents of breast cancer patients losing coverage, insurance companies agreed to end this practice immediately. Effective for health plan years beginning on or after September 23.

- Eliminates lifetime limits on insurance coverage. Under the new law, insurance companies will be prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays.

- Regulates annual limits on insurance coverage.  Under the new law, insurance companies' will find it harder to limit the amount of insurance coverage a patient may receive. [In 2014, the use of annual dollar limits on essential benefits like hospital stays will be banned for new plans in the individual market and all group plans.]

- Extends coverage for young adults. Requires any group or individual health plan that provides dependent coverage for children to continue that coverage until the child turns 26 years of age. Effective for policy or plan years beginning on or after September 23, 2010 and applying to all plans in the individual market, new employer plans, and existing employer plans if a young adult is not eligible for employer coverage. However, many of  the nation’s health insurers (including the four largest insurers) and self-insured organizations have agreed to implement this change well before the effective date.

- Improves Consumer Assistance. Requires that any new group health plan or new plan in the individual market implement an effective appeals process for coverage determinations and claims. Effective for policy or plan years beginning on or after September 23, 2010.  The law also provides consumers with an easy way to appeal to their insurance company and to an outside board if the company denies coverage or a claim.

Covering Preventive Health Services. All new individual and group health plans and plans must provide first dollar coverage for preventive services.

December 31

Reporting Health Coverage Costs on Form W-2. Requires employers to disclose the benefit value for each employee's health insurance coverage on the employee's annual Form W-2. Effective for tax years beginning after December 31, 2010.

Standardizing the Definition of Qualified Medical Expenses. Defines qualified medical expenses for HSAs, FSAs, and HRAs to fit the itemized deduction. But over-the-counter medicine with a prescription still qualify as medical expenses. Effective for tax years beginning after December 31, 2010.

January 1, 2011

Filling the Part D ‘Donut Hole.’ Provides a 50 percent discount on all brand-name drugs and biologics purchased in the donut hole by beneficiaries who do not receive Medicare Extra Help. These discounts will gradually increase to completely fill the donut hole by 2020 for all Part D enrollees. [Sorry, I don't know what a donut hole is; at least not this kind/ RF).

Improving Preventive Health Coverage. Provides a free, annual wellness visit and personalized prevention plan services for Medicare beneficiaries and eliminates cost-sharing for preventive services.

Improving Transitional Care for Medicare Beneficiaries. Establishes the Community Care Transitions Program to provide transition services to high-risk Medicare beneficiaries. .

Expanding the Adoption Credit and Adoption Assistance Program. Increases the adoption tax credit and adoption assistance exclusion by $1,000, makes the credit refundable, and extends the credit through 2011. Effective for tax years beginning after December 31, 2009.

More changes are due over the next four years.

Information on implementation of the Affordable Care Act is available and at

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