The health care law enacted in 2010 brings a number of benefits to all Americans, including people over age 50. Some of these benefits are available now. Others phase in over the next few years.
The health care law:
- makes it easier for you to get and keep your health insurance
- makes discriminatory insurance practices a thing of the past
- makes health insurance easier to get and more affordable
- strengthens Medicare
- helps with long-term care services
If you buy health insurance on your own, have insurance through your employer, can't get or afford insurance, or have Medicare, the health care law may affect you. By understanding what's in the law, you can make better health care choices for you and your family.
For all Americans
- The health care law ends unfair insurance practices: Health insurance companies can no longer drop your health coverage if you become sick. (Your health insurance is guaranteed so long as you pay your premiums.) Children under age 19 can't be denied health insurance because of a pre-existing condition. In 2014, adults also can't be denied health insurance because of a pre-existing condition.
- The health care law ends lifetime and annual limits on coverage: By prohibiting insurance companies from setting dollar limits on the amount of medical care it will cover, your benefits won't run out when you need them the most. The protection against lifetime limits began in 2010 and the ban on annual limits will take effect in 2014.
- The health care law requires coverage for preventive care: Most health insurance plans, including Medicare, must now cover — without cost to the patient —proven preventive care services such as immunizations and screenings for diabetes and certain cancers. (For instance, mammograms and colonoscopies are covered.)
- The health care law helps contain premium costs: Insurance companies must now justify any rate increase of 10 percent or more.
For people who are uninsured or buy their coverage
- The health care law makes it easier to buy health insurance: People without insurance, small businesses and self-employed people can buy private health insurance though a health insurance exchange. Exchanges allow people to compare plan benefits and costs, and purchase coverage. State-based exchanges must begin offering insurance by 2014. If you are uninsured and eligible for coverage through an exchange — but do not purchase insurance — you will be subject to a penalty.
- The health care law creates a set of standard benefits: All health insurance plans in the exchanges must offer a basic set of benefits that include medical, mental health, prescription drug and rehabilitation services. The standard benefits will make it easier for you to compare benefits and costs, and then pick among several levels of coverage to best fit your needs.
- The health care law makes health coverage more affordable: Starting in 2014, if you earn less than about $59,000 as a couple or about $44,000 as an individual, you may be eligible for tax credits to help you pay for health insurance purchased through an exchange. (These income levels are based on the 2011 federal poverty rate and are subject to change; higher income levels apply in Alaska and Hawaii.)
- The health care law expands eligibility for Medicaid: Starting in 2014, all uninsured children, parents and childless adults who live on less than about $15,000 in income, or about $21,000 for a couple, will qualify for Medicaid coverage. (These income levels are based on the 2011 federal poverty rate and are subject to change; higher income levels apply in Alaska and Hawaii.)
- The health care law covers people with pre-existing conditions: If you have a pre-existing condition, have been denied insurance because of your health and have been uninsured for at least six months, you may be able to purchase health coverage through a Pre-existing Condition Insurance Plan (PCIP) in your state. The PCIPs operate until the exchanges and pre-existing condition protections begin in 2014.
- The health care law extends coverage for young adults: The law lets you include your children on your family health insurance plan until they reach age 26. (Check with your employer or health plan about keeping or adding an adult child to your plan.)
For people who have Medicare
- The health care law expands coverage for wellness and preventive care: The law protects your guaranteed Medicare benefits and covers annual wellness visits and screenings for diabetes and certain cancers — at no cost to you. Be sure to make an appointment with your primary care doctor to take advantage of these new preventive care services.
- The health care law lowers out-of-pocket prescription drug costs: If you reach the Medicare Part D coverage gap, or "doughnut hole," in 2012, you'll receive a 50 percent discount on your brand-name prescription drugs and a 14 percent discount on your generic prescription drugs while you're in the coverage gap. The gap will get smaller until it disappears in 2020. As long as you are enrolled in a Medicare Part D plan, you don't need to do anything to get these benefits.
For people planning for long-term care
- The health care law provides better information and accountability for nursing home care: It's now easier to file complaints about the quality of care in a nursing home. You also have access to more information on nursing home quality and resident rights.
- The health care law extends financial protections to the spouses of people on Medicaid: If you're married to someone on Medicaid who is receiving care services at home, you will have the same protections for your income and other resources as do spouses of people on Medicaid who live in a nursing home. These protections begin in 2014.
- The health care law promotes independent living: Your state may receive financial incentives to provide greater access to the services and supports you need to live independently in your own home and community.
Also of interest: More fact sheets about the health care law.
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