The Health Care Law: What's in Effect Now, What's Still to Come
Benefits are in place, with more coming through 2014
Editor's Note, October 2013: For current information about benefits under the Affordable Care Act, visit Your Guide to the Health Care Law. To receive a personalized report about how the health care law can help you and your family, use the AARP Health Law Answers Tool. To shop for health insurance through the health insurance marketplace, visit HealthCare.gov.
The Affordable Care Act — also referred to as the health care law or "Obamacare" — was signed into law on March 23, 2010.
Last June, the U.S. Supreme Court upheld the law. And starting this October, people who have been denied coverage because of a pre-existing health condition, or haven't been to afford the high costs of individually purchased insurance, will be able to sign up for lower-priced group plans. These policies, and other protections in the law, will go into effect on January 1, 2014.
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Here's your at-a-glance guide to the provisions and benefits available now, as well as some still to come.
Benefits in Effect Now
Expanded coverage for preventive care and screenings
People who have Medicare Part B as well as those covered by many individual and employer-sponsored health plans are eligible for free — i.e., no deductibles or copayments — preventive and wellness benefits, such as annual health exams, immunizations, mammograms and other screenings for diseases including diabetes and certain cancers. For instance, Medicare Part B enrollees can have a free wellness visit with their doctor every year. (See "What You Need to Know About the New, Free Medicare Checkup.") People with other types of insurance can ask their insurance company or physician about the free preventive services now available to them.
New options for people with pre-existing conditions
Soon after passage of the law, adults whom private insurers considered to be "high-risk" and uninsurable due to prior or current health problems — and who had been uninsured for at least six months — were able to buy temporary insurance through the federal Pre-Existing Condition Insurance Plan (PCIP). More than 100,000 people enrolled in the program. Starting on January 1, 2014, all Americans will be eligible to purchase affordable insurance regardless of their health status or pre-existing medical conditions.
Lowered costs for people in the Medicare Part D "Doughnut Hole"
People with Medicare Part D who fall into the prescription drug coverage gap receive a 52.5 percent discount on most brand-name prescriptions and biologic drugs, as well as a discount on generic drugs. For 2013, the generic drug discount is 21 percent. (To learn more, see the Ms. Medicare columns "Paying Less for Drugs in the Doughnut Hole" and "Can a Drug Cost You Less in the Doughnut Hole?") Since the law's enactment, more than 6.1 million people with Medicare have saved $5.7 billion on prescription drugs. In 2012, Part D enrollees who reached the gap saved an average of $706 a year in their prescription costs.
Greater consumer protections against insurance cancellations
A common practice among insurers seeking to deny payments for costly medical care has been to re-examine customers' initial applications and cancel or "rescind" policies. Now, due to the health care law, as long as you pay your premiums, your health insurance is guaranteed. The health care law prohibits insurers from rescinding coverage because of unintentional mistakes or minor omissions on an application.
An end to lifetime limits on health insurance coverage
Insurers can no longer limit how much they will pay out in essential medical services over a person's lifetime. This benefit is now automatically in effect on all insurance policies.
Higher annual limits on health insurance coverage
Most insurance plans must now cover medical expenses up to at least $1.25 million per year. (See page 3 for more about annual coverage limits).
Expanded coverage for adult children up to age 26
Young adults who don't have access to an employer health plan can now stay on a parent's health insurance policy until they turn 26, even if they are married or don't live at home. Previously, most insurance plans kicked young adults off family policies when they turned 18 or, if the young adult was in college, soon after graduation.
Next page: More benefits, including help for early retirees. »
Insurance supports for early retirees
If you have retiree health coverage through your work and are between 55 and 64, funding from the new Early Retirees Reinsurance Program can help your former employer maintain your health benefit until you reach Medicare age.
Greater protections for children with pre-existing conditions
Under most individual and group insurance plans, children up to age 19 with prior or current health problems can no longer be denied coverage.
Free wellness care for babies and children
Children are eligible for free annual wellness exams and immunizations from birth to age 21.
Easy-to-use resources for finding affordable insurance
Consumers seeking to research private and public health insurance plans, obtain rate information, and better understand their insurance options can now visit a one-stop shopping website established by the federal government.
Easier access to specialty care
Among the "patient bill of rights" provisions in effect now are rules that prevent insurance companies from requiring primary-care physician referrals for ob/gyn visits or out-of-network emergency care.
Expanded rights of appeal
If an insurer rejects a claim or cancels coverage, customers of most plans now have the right to appeal the decision to an outside review panel. Unlike in the past, insurers will have to abide by that group's findings.
Greater protections for nursing home residents
The new health care law provides expanded resources, such as access to quality ratings and complaint reports, for families seeking nursing home care and greater protections for nursing home residents.
Insurance supports for small-business employers
Business tax credits have been established for small business owners who want to provide health insurance to their workers.
Next page: Additional benefits still to come. »
Benefits Still to Come
An end to denials and expensive premiums due to gender or pre-existing conditions
As of Jan. 1, 2014, insurance companies will no longer be able to deny adults health coverage because of pre-existing conditions, or charge higher premiums due to gender or gender-specific medical needs, such as childbearing.
The creation of health insurance exchanges
Also in 2014, most individuals and families will be required to carry a minimum level of health insurance. People without employer or other group coverage will be able to purchase insurance more affordably through state-based health insurance exchanges. Premium subsidies will be available for individuals and families with limited incomes. People who select not to have health insurance coverage could face a fine.
Expanded mental health and substance abuse services
While many group insurance plans today do include mental health and addiction services, by 2014 most individual and small group insurance plans will be required to do the same.
An end to annual insurance limits on health coverage
In 2013, insurers will be required to cover medical expenses of up to $2 million per year. In 2014, the coverage limit will be eliminated entirely.
Insurance coverage for more low-income people
In 2014, more people will be eligible to enroll in Medicaid, the federally run public health insurance program for low-income people.
End of the Medicare Part D Doughnut Hole
In 2020, the Medicare Part D coverage gap, or doughnut hole, will completely close.
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