All information and quotations below were taken from the US Department of Health and Human Services' (HHS) publication "Understanding the Affordable Care Act: Timeline: What's Changing and When,” available at www.healthcare.gov/law/timeline/index.html (accessed Sep. 21, 2010). Entries were chosen based upon their relevancy to individual consumers of health care and do not represent a comprehensive listing of all changes that the reforms will insitute.
July 1, 2010
Establishment of Pre-Existing Condition Insurance Pools - "A Pre-Existing Condition Insurance Plan will provide new coverage options to individuals who have been uninsured for at least six months because of a pre-existing condition. States have the option of running this new program in their state. If a state chooses not to do so, a plan will be established by the Department of Health and Human Services in that state. This program serves as a bridge to 2014, when all discrimination against pre-existing conditions will be prohibited."
Sep. 23, 2010
Coverage for Young Adults until Age 26 - "Under the new law, young adults will be allowed to stay on their parents' plan until they turn 26 years old (in the case of existing group health plans, this right does not apply if the young adult is offered insurance at work)."
Free Preventive Care- "All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance."
Insurance Companies Can No Longer Rescind Coverage - "In the past, insurance companies could search for an error, or other technical mistake, on a customer’s application and use this error to deny payment for services when he or she got sick. The new law makes this illegal."
Appealing Insurance Claim Denials - "The law provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an external review process."
No More Lifetime Limits on Insurance Coverage – "Under the new law, insurance companies will be prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays."
Regulating Annual Limits on Insurance Coverage - "Under the new law, insurance companies’ use of annual dollar limits on the amount of insurance coverage a patient may receive will be restricted for new plans in the individual market and all group plans."
Children with Pre-Existing Conditions Cannot Be Denied Coverage - "The new law includes new rules to prevent insurance companies from denying coverage to children under the age of 19 due to a pre-existing condition."
Jan. 1, 2011
Medicare Prescription Drug Discounts - "Seniors who reach the coverage gap will receive a 50 percent discount when buying Medicare Part D covered brand-name prescription drugs. Over the next ten years, seniors will receive additional savings on brand-name and generic drugs until the coverage gap is closed in 2020."
Preventive Care for Seniors- "The law provides certain free preventive services, such as annual wellness visits and personalized prevention plans, for seniors on Medicare."
Insurance Premium Rebates- "To ensure premium dollars are spent primarily on health care, the new law generally requires that at least 85% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement. For plans sold to individuals and small employers, at least 80% of the premium must be spent on benefits and quality improvement. If insurance companies do not meet these goals because their administrative costs or profits are too high, they must provide rebates to consumers."
Oct. 1, 2011
Home and Community Health Care Services - "The new Community First Choice Option allows States to offer home and community based services to disabled individuals through Medicaid rather than institutional care in nursing homes."
Jan. 1, 2014
Health Insurance Exchanges to Be Established - "If your employer doesn’t offer insurance, you will be able to buy insurance directly in an Exchange - a new transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Exchanges will offer you a choice of health plans that meet certain benefits and cost standards. Starting in 2014, Members of Congress will be getting their health care insurance through Exchanges, and you will be able buy your insurance through Exchanges too."
Individual Insurance Mandate to Be Instituted - "Under the new law, most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans. If affordable coverage is not available to an individual, he or she will be eligible for an exemption."
Medicaid Expansion to Be Instituted - "Americans who earn less than 133 percent of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid. States will receive 100 percent federal funding for the first three years to support this expanded coverage, phasing to 90 percent federal funding in subsequent years."
Tax Credits for Purchasing Insurance - "Tax credits to make it easier for the middle class to afford insurance will become available for people with incomes above 100 percent and below 400 percent of poverty ($43,000 for an individual or $88,000 for a family of four in 2010) who are not eligible for or offered other affordable coverage. These individuals may also qualify for reduced cost-sharing (e.g. copayments, coinsurance, and deductibles)."
Elimination of Annual Limits on Insurance Coverage - "The law prohibits new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual may receive."
Prohibition on Refusing Coverage Due to Pre-Existing Conditions or Gender- "The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, it eliminates the ability of insurance companies to charge higher rates due to gender or health status."