Obamacare goes into effect in September of 2010

Obamacare was signed into law six months ago. As of September 23, 2010 this new health care law goes into practice. What are the changes? How will it affect me? What do I need to know? All of those questions are answered on this web page for you.

For Working Folks

If your health care plan is through your employer, then for health care plans that kick in after September 23rd, the biggest changes are:

• Keeping your adult children on your plan up to age 26.
• No lifetime limit on your coverage.

If your employer makes significant changes to your plan – cutting benefits or raising your out-of-pocket costs – the plan is considered to be a “new” plan. It must include a wider set of consumer protections. Some of those benefits are:

• Preventive services such as breast cancer screenings and cholesterol tests are free.
• You can see your obstetrician and pediatrician without prior authorization.
• Recommended immunizations for children are also free.

For Business Owners

First, no business owner – small or large – is required by law to offer coverage.

But, small business owners with 25 or fewer full-time employees who earn an average yearly salary of $50,000 or less, will:

• Qualify for a tax credit up to 35% of the cost of premiums.
• The credit increases to 50% in 2014.
• Owners must cover at least 50% of the cost of the workers’ insurance.

In 2014, business owners with 50 or more employees that do not provide health care coverage and have at least one full-time worker who receives subsidized coverage will:

• Have to pay a fee of up to $2,000 per full-time employee.
• The first 30 workers would be excluded from the fee.
• Owners with 50 or fewer workers are exempt from this fee.

For Individual Policy Holders

For all policy years starting after September 23rd, 2010, according to Obamacare, health plans:

• Cannot cancel coverage when you get sick. Insurers call this “rescission”.
• Will be prohibited from setting lifetime limits on your coverage.
• Must allow you to keep an adult child up to age 26 on your policy.
• Cannot deny coverage for children up to age 19 based on pre-existing medical conditions.

“Grandfathered” plans (with no changes in coverage after September 23, 2010) can:

• Deny coverage to children up to age 19 based on pre-existing conditions.
• Set annual dollar limits and require cost-sharing for some preventive services.

Most people who buy an individual policy will have a new plan by 2014, so those things will not be an issue.

Other Changes in 2014

Insurers will not be able to refuse coverage for adults with pre-existing medical conditions.

If your income is 400% of the poverty level or less - $82,000 for a family of four in 2010 – you will qualify for subsidies. This is to help purchase health insurance on exchanges or marketplaces where consumers can shop for coverage.

You will be required to have health insurance or pay a fine, according to the new health care law.

For Medicare Patients

The basic package of Medicare benefits will not shrink. They will expand to cover more. The only changes may occur to Medicare Advantage plans. That is, a private plan that offers Medicare benefits.

To help pay for this new health care law, Washington is cutting payments to Medicare Advantage plans in 2012. Some of these Advantage plans may reduce benefits such as eyeglasses and gym memberships.

Beginning next year for Medicare patients:

• They will not have to pay deductibles or co-payments for preventive healthcare services:
  • Diabetes checks
  • Cervical cancer screenings
• They will not have to pay for an annual wellness visit to the doctor.

Medicare Prescription Drug Benefits

As of August 1, 2010, about 1 million Medicare patients received a $250 check to help pay for prescription drugs that fell into the “doughnut hole”. That is the gap in coverage, where you must pay 100% of the cost of your prescriptions. The gap in 2010 was between $2,830 in total drug costs and $4,550 in true out-of-pocket expenses.

Starting next year, Medicare patients will receive a 50% discount on brand-name drugs and a 7% discount on generic drugs while they are in the coverage gap. The new health care law closes the gap entirely by the year 2020.

Conclusion

There is much uncertainty about Obamacare. Contrary to popular belief, there are no death panels or committees to determine your coverage. If anything, there are more consumer protections built into the law. You cannot be denied coverage and there are no limits on the amount of dollars your policy will allow. Share this good news with others.

Written by: Margaret Stenerson-Reynolds
September 24, 2010