Health Care Reform Frequently Asked Questions
What is federal health reform?
Federal health reform, officially titled the Affordable Care Act (ACA), is a strategic approach to improving the quality of health care and reducing healthcare costs for individuals and businesses. Health reform will make significant changes to the healthcare and insurance industries.
When does health reform happen?
Health reform was signed by President Obama on March 23, 2010. A majority of the laws mandates have already been implemented, with many of the remaining mandates to be in place by 2014.
Doesn't everyone get free coverage now that health reform is in effect?
This is a common misunderstanding. There is guaranteed coverage, but currently only for applicants less than 19 years of age. Starting in 2014, adults will be guaranteed coverage, regardless of any pre-existing conditions.
Those who can afford it will still need to pay for coverage. In 2014, those who do not have the financial means to purchase coverage through a carrier may go to an Exchange which will be an alternative marketplace for affordable, quality health plans and obtain coverage with some portion of the cost subsidized by the federal government.
Until 2014, some states have a high-risk pool insurance program which is a temporary program that provides health insurance for individuals who have been denied coverage or charged higher rates due to pre-existing conditions.
What are some of the health reform changes that are impacting my current individual policy (a policy not offered through an employer)?
Unless your policy was in effect prior to March 23, 2010, claims for children under the age of 19 covered under your policy cannot be denied even if the claim is for a medical condition that existed before the child was covered.
Policies that provide dependent coverage must continue to make coverage available to children until their 26th birthday.
What are some of the changes that will impact my individual policy (a policy not offered through an employer) in the long term?
Unless your policy was in effect prior to March 23, 2010, an adult's claims cannot be excluded from coverage due to pre-existing conditions.
Unless your policy was in effect prior to March 23, 2010, health status cannot be used as a factor in determining insurance premiums. Premium rates charged may vary only by family structure, rating area, age and tobacco use.
These changes will take effect in 2014.
When will all pre-existing limitations for dependent children under the age of 19 be removed?
All group health plans and policies will remove this limitation upon renewal on or after September 23, 2010. All individual and family health plans and policies that have a pre-existing condition limitation should be modified as of January 1, 2011 for individual and family plans.
When will the federal government offer coverage through the high-risk pool for uninsured people with pre-existing health conditions?
The health reform law requires that federally funded high-risk pools be available in every state. Most states implemented a high-risk pool in 2010.
Can I be turned down for coverage if I have a pre-existing condition?
No applicant under the age of 19 may be denied coverage due to pre-existing conditions.
Beginning in 2014, a health carrier cannot reject an application for coverage based on medical history.