A Simple Guide to Today's Healthcare Reform Changes

Today the next stage of healthcare reform arrived on the scene, meaning a change in landscape for providers, insurance companies, and patients.

Several changes will begin taking shape this week. Here’s a look at what we will see as the autumn open enrollment period approaches (some changes won’t be felt until January 1st, when many new healthcare plans kick in):

  • Free preventive services.  Preventive care such as immunizations, breast cancer screenings, prostate and cervical exams, blood pressure checks, and cholesterol tests will not be subject to deductibles or co-pays.  This will lead to an increase in the amount of patients seeking these services.
  • Easier OB/GYN and pediatric visits. Prior authorizations for visits to obstetricians and pediatricians will no longer be required.
  • No “Out of Network” charges for some emergency services.
  • No lifetime limits on coverage.  If you sign up for a new plan after Sept. 23, you can keep it for life.
  • Rescission ban. Insurers will no longer be able to cancel individual coverage if a customer gets sick.
  • Adult child coverage extended. Parents can keep their children on family plans until the kids hit 26.
  • Pre-existing condition changes for children and adults. Insurers will no longer be able to bar children with pre-existing conditions as of this fall; the same rule goes into effect for adults in 2014.
  • Small business tax credits. Companies with 25 of fewer employees, who make $50,000 on average, will get a 35 percent tax break on the cost of premiums. The credit is slated to rise to 50 percent in 2014.
  • Subsidized care for low-income families. Families and individuals with income levels of 400 percent of the poverty line will qualify for subsidized coverage.
  • Significant changes trigger new plan status. If employers make significant changes to healthcare plans, i.e. raise employee premiums or cut benefits, the plan is deemed new and falls under the new guidelines.
  • New insurance company decision appeal process.  The law requires insurance companies to set up an outside appeals process for claims that are denied.
  • Medicare wins, Medicare Advantage loses. Basic Medicare benefits are set to grow, but Medicare Advantage plans — privately administered Medicare plans — could see benefits shrink.

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