Health Law’s 8 New Changes To Insurance – With 7 Caveats

If you’ve tuned out the health care law you might want to tune back in.

A set of new consumer protections officially went into effect yesterday, Sept. 23, the six-month anniversary of the law.

Here’s a guide to some of the changes – and some of the 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, 2011. And, 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-pays 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 a preexisting medical condition. 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 cannot cancel coverage once you get sick, a practice known as “rescission.”
BUT: If you committed outright fraud and intentionally 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, like 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 cannot require higher co-payments 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 be raised to $750,000 for all employer plans and new individual plans, rising to $1.25 million after Sept. 23 of 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 of the health law have been around for a while they’re worth noting, too:

High-Risk Pools: Designed to help people who have been uninsured for six months get coverage. Each state has its own pool. 

Help to Companies 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.