Coverage for Preexisting Conditions For Children
Insurance companies will be required to pay for the treatment of preexisting conditions for children who have insurance. Before this new law, insurers were allowed to deny treatment to children who had insurance under the auspices of having a preexisting condition.
Was this requirement necessary? According to the Washington Post, “Even when offering coverage, insurers can exclude whole categories of illnesses related to a preexisting condition. For example, someone with a preexisting condition of hay fever could have any respiratory system disease – such as bronchitis or pneumonia – excluded from coverage.”
Unfortunately, health insurance companies continue to deny coverage for babies born with health problems and may continue to deny coverage to any child (or adult) with a preexisting condition until the full scope of the law takes effect in January 2014.
- Preexisting Conditions - Understanding Exclusions and Creditable Coverage
- Gap in Health Care Law's Protection for Children
Coverage for Adult Children
Insurance companies will no longer be permitted to arbitrarily drop kids from their parents' insurance policies when they turn 18. Health care plans must now give parents the option of keeping adult children on their policies up until the child's 26th birthday. This provision will help college students required to prove insurance coverage as an admissions requirement and for young adults that have not been able to get insurance elsewhere.
Free Preventive Care
Starting in 2010, new private plans will be required to provide free preventive care: no co-payments or deductibles can be charged for preventive services. And beginning January 1, 2011, Medicare will do the same.
This reform will help more kids get well-child check-ups to detect potential health problems early as well as help people with heart disease, cancer, and diabetes be diagnosed earlier, receive faster treatment, and will aid in the prevention of long-term complications of treatable diseases which not only cost more in consumer dollars, but cost people their lives.
Beginning in 2009, Medicare recipients will get a $250 rebate for drugs purchased while in the "Doughnut Hole," a gap in the Medicare Part D prescription drug coverage plan. Medicare Part D currently covers up to $2,700 per year in prescription drug payments then stops paying for medications until costs exceed $6,100. This means Medicare Part D coverage recipients are responsible for paying all their own drug costs between $2,700 and $6,100. In 2011, recipients in the doughnut hole will get a 50 percent discount on medications and the donut hole will will be eliminated completely by 2020.
National High-Risk Insurance Pool
People who are uninsured because of preexisting conditions will have access to affordable insurance through a temporary subsidized national high-risk pool (the pool is to be in place as of June 2010 and be faded out by 2014.)
Currently, many states have high-risk pools, but most state programs only accept a limited number of applicants each year and have strict requirements that have can make state programs inaccessible.(i.e., COBRA benefits must be exhausted and coverage premiums can still be extremely high.)
Insurance Policy Rescission Will Be Illegal in All States
Federal law will now make insurance rescission illegal in all 50 states. This means that insurance companies can no longer drop people from coverage when they get sick or file a claim.
- Post Claim Underwriting: Canceling Insurance Coverage When It's Needed Most
- What Is Insurance Rescission?
No More Lifetime Policy Caps
Insurance companies can no longer place lifetime caps on coverage.
New Appeals Process
In 2010, the new health care reform law establishes a new, independent appeals process that ensures consumers in new private plans have access to an effective process to appeal decisions made by their insurer. Currently, consumers who have had to fight insurance companies for coverage for treatment have had to turn to attorneys because insurance companies often use doctors and claim agents who receive financial rewards for denying insurance claims.
Other Provisions That Take Effect in 2010
The new law also allows for increased funding for community health centers and to fund programs intended to increase the number of doctors, nurses, and public health professionals.