Q. I retired at age 59 and thought I was lucky to get health insurance through my former employer. Now my plan won't cover my 23-year-old daughter because I'm told the new health care reform law doesn't apply. Is that possible?
A. That's correct, the law doesn't apply to your policy. These plans enjoy a number of exemptions because Congress wants to protect them and when the new law was passed, those exemptions remained. Now, only about 25 percent of employers with 500 or more workers offer their retirees health insurance and of those, only about half provide retiree-only health insurance. If you are in a retiree-only health plan, it doesn't have to comply with a host of consumer protections the law now requires of most other types of plans. For example, retiree-only plans do not have to:
- cover your children until age 26.
- offer free preventive health benefits.
- spend at least 80 percent of your premium on medical services.
- remove annual and lifetime limits on how much they will spend on medical care.
- remove limits on emergency health care.
- offer a process inside or outside the plan to appeal a claim denial.
There is also another category of health care plans that are exempt from many of the health reform provisions. Congress created an exception for "grandfathered" plans, employer plans that were in existence before health care reform was signed into law — on March 23, 2010 — and have made few or no changes in their coverage.)
Susan Jaffe of Washington, D.C., covers health and aging issues and writes the Bulletin’s weekly column, Health Care Reform Explained: Your Questions Answered.