How The New Health Care Law Affects You

Source: Washington State Insurance Commissioner
UPDATED: 6/10/2010
 
Health reform was signed into law this past March and while most of the new benefits take effect in 2014, some significant changes start as early as this summer.  Most people who’ve contacted the state insurance commissioner want to know the same thing: How does the new law impact me?  Here, you’ll find the latest information on the new law for different age groups as well as a general timeline. Check back often, as we’re updating this page when new information becomes available.

 

Within 90 days:
■Washington state will contract with the federal government to create a new, temporary high risk pool for people who’ve been uninsured for at least six months and who have a pre-exisitng medical condition.
■Approximately $102 million will be available from the federal government to fund Washington state’s program until 2014, when the new reforms take effect. Many details about the benefits and costs have yet to be set, but the program should be up and running later this summer.
■The federal funds will pay at least 65 percent of the cost of enrollee health care services and the maximum enrollee annual out-of-pocket limit will not exceed $5950. Learn more about the new, temporary program and Washington’s current high risk pool, WSHIP.
■Employers can apply for federal funds to help cover their retirees’ health care costs.
 Many of the following new benefits take place at different times, depending on whether you have an individual plan or get your health insurance from your employer.

 

Beginning Sept. 23, 2010:
When your employer-sponsored health plan renews, your plan cannot:

■Charge out-of-pocket costs for preventive services.*
■Cap Lifetime benefits. (Caps of $1 million or $2 million are now common).
■Cancel or rescind a policy, except in the case of fraud or misrepresentation.
■Refuse to cover pre-existing conditions of enrollees under age 19.
■And young adults may be covered on their parents’ plan until the age of 26, unless they get a job that offers health insurance.

 
* If your employer enrolled in its plan before March 23, 2010, your plan is considered grandfathered and isn’t required to include these benefits.

 

Beginning Jan. 1, 2011:
If you have an individual plan, your plan cannot:

■Charge out-of-pocket costs for preventive services.*
■Cap lifetime benefits. (Caps of $1 million or $2 million are now common).*
■Cancel or rescind a policy, except in the case of fraud.
■Refuse to cover a child’s pre-existing condition.*
■And young adults may be covered on their parents’ plan until the age of 26.

 
* If you enrolled in your individual plan before March 23, 2010, your plan is considered grandfathered and isn’t required to include these benefits.

 

This year:
■Medicare enrollees with prescription drug coverage (Part D) will receive a one-time check of $250 to help pay for their medications in the coverage gap (“doughnut hole”).
■Small businesses will not be required to continue coverage for their employees up until 2013, but they’ll receive tax incentives if they do. If they pay for at least 50 percent of their employees’ premiums, they can receive a tax credit equivalent to 35 percent of their contribution.
■Washington state will begin applying for federal grants to implement the new health reform law.
 

In 2011:
■Drug manufacturers must provide a 50 percent discount to Part D (Medicare’s prescription drug benefit) for brand name drugs.
■ A new voluntary long-term care program, called the CLASS Act, begins. It provides a modest cash benefit to help disabled people stay in their homes, or cover nursing home costs. Benefits can begin five years after people start paying the premium. More details, including premium amounts and the amount of case benefits that’ll be available will be announced later this year.

 
In 2014:
■Health plans cannot exclude coverage for pre-existing conditions.
■Health plans must accept every employer and every individual that applies for coverage, although they may create special enrollment periods.
■Health plans cannot require individuals to take a health questionnaire or deny them coverage because of their health condition.
■Individuals and families can receive subsidies, based on their income, to help buy coverage from their state’s health insurance exchange. Also, income-based caps on out-of-pocket medical expenses take effect.
■People under age 30 can purchase a comprehensive coverage plan or a catastrophic plan designed just for their age group.
■Small businesses can purchase insurance for themselves and their employees through the health insurance exchange. Their tax credit will increase to 50 percent of premiums and last for two years. The tax credits are available to employers with fewer than 25 workers and average wages below $40,000 a year.
■From 2014-2019, Washington state will receive $13.78 billion to help pay for health insurance coverage for the uninsured, either through subsidies for low and middle income families or through the state’s Medicaid program for the very poor.
  

In 2020:
■The coverage gap or “doughnut hole” in Medicare’s prescription drug program closes.

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