Posted by Michael Barber, August 27, 2013 (last updated on November 27, 2018)
Healthcare reform, officially titled the Patient Protection and
Affordable Care Act and also referred to politically as "Obamacare", passed in March 2010 and goes into effect in 2014. Perhaps
no bill in history has been more confusing to the public than this one, but
there are some important things consumers should know.
#1 Not All States Are Participating
Many of the citizens who worry about the broad changes to healthcare and Medicare won't even have to face the issue. The original bill required states to participate until at least 2017, but Obama made concessions to governors and revised the bill so that states can opt out as early as 2014, meaning many states won't really participate under the full force of the bill at all. Under current governors' administrations, only 28 states plan to fully participate in the health care reform. You can see a current list of where each state stands on this issue here.
#2 Some Companies Would Rather Pay Fines
Companies aren't forced to comply with the new changes. The healthcare act only applies to companies with 50 or more employees, and a considerable portion of those companies have chosen to simply pay fines and fees for non compliance instead of trying to abide by the regulations. Talk to your human relations department if you are in a participating state and aren't sure if your company intends to offer family care under the act.
#3 Insurance Can't Drop You if You Get Sick
One of the reasons the healthcare act passed is because insurance companies were accepting premiums from customers for years, but when the person faced immediate healthcare issues, the company cancelled their policy and declined to pay their costs. The healthcare reform act makes this illegal.
#4 If a Claim is Denied, Patients Have Options
Before the law passed, insurance companies could simply deny a patient's claim and there was nothing the patient could do except pay the bill out-of-pocket. The new law makes this harder to do to people. If the insurance company denies a claim, the insured can get an independent reviewer to look over the claim. In emergency or urgent care situations, the independent reviewer must make a decision within 72 hours.
#5 Lifetime Limits on Health Care Payouts are Illegal
For years, companies have imposed a lifetime limit on how much they'll pay for an insured's healthcare expenses. The new law bans this practice. Most patients never face the lifetime limit, but those with chronic illnesses such as cystic fibrosis or Crohn's disease are often left without coverage, even after diligently paying their premiums.
#6 Annual Limits on Insurance Benefits Also Banned
Insurance companies also habitually denied to pay healthcare costs over a certain amount each year. This didn't affect those who occasionally needed a walk-in clinic, but it did apply to people who had serious traffic accidents or a sudden cancer diagnosis. This practice is banned under the health care reform acts.
#7 Much Preventative Care is Now Free
Many illnesses can be prevented or controlled with the proper checkups and preventative care, such as cancer screenings and immunizations. The affordable health care act makes many of these appointments, tests and treatments free, so health care will be cheaper because many illnesses are stopped before causing a problem.
Talk to your employer and doctor to find out exactly how the new law affects you.