By Stacy Collins, MSW
The Health Reform law is important to the health and well-being of all Americans. This law is also called the Affordable Care Act. Here are some of the Health Reform law’s most important benefits for people.
More people now get health care.
Coverage for young adults: Parents can keep their children on their health plans until age 26. Ask your insurance company how this works.
Coverage for workers: Some small businesses can get a tax credit to help pay the cost of health insurance for their workers.
Preventive health care services now cost less.
Preventive care: All new group and individual health insurance plans now must cover checkups and other preventive services for free. No more copays and no deductibles. It is the same for Medicare. Examples of preventive services include vaccinations to reduce risk of diseases such as the flu and pneumonia, mammograms, and screenings for cholesterol, high blood pressure and cancer.
Drug discounts for seniors: Seniors in the Medicare Part D prescription coverage “donut hole” (i.e., those paying 100% of their prescription costs) now get a 50% discount on their prescription drugs. The “donut hole” will be completely closed by 2020.
There are now stronger protections for people.
Insurance companies cannot deny insurance coverage to children and adolescents (under age 19) who are already sick or have a medical condition. They also cannot say they won’t cover the sickness or medical condition.
Insurance companies cannot cancel your insurance when you get sick (as long as your insurance bill is paid).
Insurance companies cannot put lifetime limits on the dollar amount of your medical coverage (as long as your insurance bill is paid). The yearly limits on the dollar amount of medical coverage will go away by 2014.
And, starting in 2014…
U.S. citizens and legal residents will be required by law to have health insurance. If they don’t, they will have to pay a fee to help pay the costs of when they do get sick. Some people will not have to pay the fee for reasons such as severe financial problems.
Under Federal law more people will be able to get Medicaid* coverage if they are under age 65 with household incomes up to 138 percent of the federal poverty level ($15,415 for a single person or $26,344 for a family of three in 2012). This is for:
- Children and adolescents
- Pregnant Women
- Parents
- Adults who do not have dependent children
Note: States do not have to provide Medicaid to more people if they choose not to. To find out if the Medicaid rules in your state will change, check with your local Medicaid office. They will be able to help you and your family enroll, if you are eligible.
New online marketplaces (called “insurance exchanges” *) in each state will offer people without health insurance and employees of small businesses a place to find out about insurance plans and shop for affordable coverage. Individuals and families who earn too much money to get Medicaid may be able to get help from the Federal government to buy insurance from an insurance exchange. Open enrollment for the exchanges will begin on October 1, 2013.
* Note: Medicaid and the insurance exchanges are for U.S. citizens and legal residents only. Undocumented immigrants are not able to get health insurance through these programs.
There will be even more protections for people starting in 2014.
If you already have a sickness or medical condition, insurance companies will not be able to keep you from getting insurance. Also, insurance companies will not be able to charge you more because you have a sickness or medical condition.
If you are a woman, insurance companies will not be able to discriminate and charge more because you are a woman.
All new health plans will have to offer unlimited yearly and lifetime coverage.
All new health plans will have a minimum package of “Essential Health Benefits.” This will include services such as:
- Outpatient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Medical and surgical care
- Mental health and substance abuse services
- Prescription drugs
- Rehabilitative services
- Laboratory services
- Preventative and wellness services
- Pediatric services (including dental and vision care)
The Affordable Care Act will bring health insurance coverage to 32 million people over the next few years. It’s important that you and your family have a health care team that can provide you with ongoing medical care.
Professional social workers are important members of the health care team. Social workers care for people in every stage of life, from children to the elderly, and help them overcome life’s most difficult challenges.
For more information about Health Reform and the Affordable Care Act, visit www.HealthCare.gov.
For more information about social workers, please click here.
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Material provided courtesy of the National Association of Community Health Centers (www.nachc.org)
Stacy Collins, MSW, is a Senior Practice Associate at NASW, specializing in adult and pediatric health care issues. Ms. Collins has over 20 years of experience in health care advocacy, education, and direct service with national and community-based organizations. As one of the NASW staff covering oncology, Ms. Collins developed a web education course for social workers on promoting adherence in oral chemotherapy, in conjunction with the National Coalition for Cancer Survivorship. Prior to joining the NASW staff, she was the project director for a federally –funded initiative to develop community engagement strategies for large-scale cancer clinical trials. Ms. Collins holds an MSW from the Catholic University of America and a BA from the University of Virginia.
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Issues And Answers
Tags: tags: Health Reform Tips for Consumers; Stacy Collins, MSW
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