This week, we’re talking about the Affordable Care Act and what better place to start than with how it began? Our great intern here at the Feronia Project put together this assessment of the Affordable Care Act.
On March 23, 2010, President Obama signed the Affordable Care Act (ACA). If implemented properly, the plan’s focus on short-term health insurance access and preventative care will lead to long-term public health benefits. The controversy surrounding the ACA, and the several-year period in which it is being implemented has caused confusion about what the act provides.
Below is a quick summary of how the ACA could affect you:
- All insurance companies are now required to submit clear summaries of their plans in a format based on the nutrition fact label. This simplification will allow consumers to more easily compare the benefits of insurance plans without the confusing jargon and vague descriptions of coverage. In some states, Consumer Assistance Programs (CAPs) have been created to help Americans file complaints and appeals to their insurance company, enroll in new policies, and learn about their health insurance rights (Check if your state has implemented this yet; Floridians, our CAP is still being developed.)
- Insurance policies created on or after September 23, 2010 have to fully cover 14 vital preventative services for women, including yearly mammograms for women over 40, and screenings for cervical cancer, gonorrhea, chlamydia, and syphilis. Other covered services for all adults are tests for blood pressure, diabetes and cholesterol, many cancer screenings, routine vaccinations, and counseling for quitting smoking, losing weight, treating depression, and reducing alcohol use. For pregnant women, policies must cover counseling, screening, and vaccines, as well all regular “well-baby” and “well-child” visits after the child is born, until age 21. A full list of all covered preventative services is available here.
- And if your health insurance policy was established on or after August 1, 2012? You’ve got twenty-two potentially life-saving preventative services for women that should be covered, including eight new preventative services, covered without co-pay:
1. Breastfeeding support and access to supplies
2. Contraception and sterilization procedures
3. Domestic/interpersonal violence screening and counseling
4. Gestational diabetes screening for pregnant women
5. HIV screening
6. HPV screening (for high risk women)
7. STI counseling for sexually active women
8. “Well-woman” visits in order to receive recommended preventative services
So, will all or some of these benefits apply to you?
If your insurance policy is “grandfathered in” (a health plan that already existed on March 23, 2010 when the ACA was signed), many of the preventative services will not yet be covered. Policies distributed through a network provider may also not yet cover these services. Doctor office visits that are not primarily for preventative services may not be covered under any policy, new or old.
However, even if your plan has been “grandfathered in,” you still have some new benefits. Insurance companies are prevented from applying “lifetime dollar limits” to your plan (i.e., they cannot stop covering you after you use a certain amount of insurance); they are not allowed to cancel plans because of simple application mistakes; and dependent coverage has been extended to children under 26. Job-based and grandfathered plans are still not required to cover preventative care, new protection on appeals, and provide choice of health care or emergency care providers, though.
Insurance companies are no longer allowed to charge more based on gender; for women, this costs approximately $1 billion a year on the current insurance market, according to the National Women’s Law Center. This protection will make a huge difference for women who are being discriminated against because of their reproductive processes. Also, insurance plans now have to include all Food and Drug Administration approved contraceptive methods, including sterilization, and necessary counseling. Individuals who are eligible for Medicaid beginning in 2014 should see an increase in coverage, making healthcare more accessible for every woman. (We’ll be talking more about this during the week.)
The Patient’s Bill of Rights, which explains your new insurance rights, is available here. The Bill (which applies to policies established on or after March 23, 2010) guarantees your right to appeal, explains no-cost preventative care services, provides coverage to adults and children with pre-existing conditions, allows you to choose any doctor from your insurance network, and removes the need for a referral for ob-gyn services.
In addition to extending coverage, the ACA creates new insurance plan options: pre-existing condition coverage, young adult coverage, and starting in 2014, a state-based health insurance marketplace and co-op insurance plans for small businesses. Also coming in 2014 are tax credits for middle class families.
Sounds good, right? Well, not everybody thinks so. We’re going to be talking about the act – why it’s disputed and the state of your state – all week.