1. Your kids are covered—once upon a time, health insurers could drop your kids as soon as they turned 19 or 25 if they are in school. But now, if you have an adult child who can’t get health care coverage from their employer, your child can stay on your policy until they turn 26.
2. You can’t be dropped from your current plan—starting this fall, your health insurance company can’t just “drop” you if you get sick. That will be a big change from the way health insurance companies used to run the show: in fact, in 2009 “rescission” was revealed to be one of the most common methods of cost-cutting.
3. You can’t be denied insurance—as heartbreaking as it is, many insurance companies kept critically ill adults and children from obtaining coverage because of so-called “pre-existing conditions”. However, starting this year health insurance companies will no longer be able to deny children with pre-existing conditions coverage and later, in 2014, adults will also be added into this new stipulation.
4. You can spend what you need to—prior to the new law, health insurance companies could set policy limits, preventing those with long-term health care problems from obtaining all the medical care that they required. But, starting this year, companies will be barred from instituting caps on coverage.
5. You don’t have to wait—remember when we were talking about “pre-existing conditions” back in #3? With the new law in place, adults with pre-existing conditions won’t have to wait until 2014 to obtain coverage. Instead, starting this fall, these adults can purchase health care coverage through a state-run “high-risk” pool, which will cap out-of-pocket costs for care. Overall, under the high-risk pool plans, these individuals won’t have to pay more than $5,950 out-of-pocket and families won’t be forced to pay over $11,900.
6. You must be insured—okay, so this is the big rift between democrats and republicans that’s driving the teapartiers crazy. Under the new law, in 2014 you will have to purchase health insurance or risk being fined. If your employer doesn’t offer health insurance or if you do not earn enough money to purchase a plan, you can still get assistance from the government.
7. You’ll have more options—starting in 2014, states will begin operating “exchanges” or new insurance marketplaces. These new exchanges will provide you with more options for buying an individual policy if you aren’t able (can’t afford) insurance from your workplace or if you make too much money to qualify for Medicaid. Similarly, millions of low- and middle-income families will be able to qualify for financial assistance from the federal government to purchase health insurance through the “exchanges”.
8. Flexible spending accounts will become less flexible—in three years, flexible spending account will have lower contribution limits. What this really means is that you will have less coming out of your paycheck pre-tax and deposited into an FSA for medical expenses. The new maximum amount will be $2,500.
9. If you earn more, you’ll pay more—starting in 2018, if your family earns more than $250,000 you will have more money deducted from your paycheck to go towards Medicare payroll taxes.
10. Medicare may cover more or less of your expenses—starting this year, if Medicare is your primary form of health insurance, you will have to pay less for annual exams, screenings for treatable conditions, and routine laboratory work. In addition, you will also get a $250 check to cover the “doughnut-hole” in prescription drug costs covered by Medicare Part D. However, if you are a high-income individual or couple (making over $85,000 individually or $170,000 jointly), your prescription drug subsidy will be reduced.
So what’s not in these “ten things you should know”? Sarah Palin’s “death panels”. The point is, get the facts: it’s very likely that in the next few months you will receive information in the mail from your health insurance company about how the newly signed bill will affect your coverage. Read all the information carefully, ask questions if you are confused, and remember that there may be more affordable options down the road in 2014.
recently named in the 2009 edition of Best Lawyer's In America, David Mittleman has been representing seriously injured people since 1985. A partner with Church Wyble PC—a division of Grewal Law PLLC—Mr. Mittleman and his partners focus on medical malpractice, wrongful death, car accidents, slip and falls, nursing home injury, pharmacy/pharmacist negligence and disability claims.