Health Care Reform Changes That Take Effect September 23

Health Care Reform is Here and So Are Changes to Your Health Insurance

It seems like it was just yesterday that we were debating health care reform, but on September 23 we hit the six-month anniversary of this reform and it also signals milestone where some changes begin to take effect. The changes you’ll personally see depend on a number of things, such as where you get your insurance, when your policy year begins, and your age/dependent status. So, here’s what to be on the lookout for as these health insurance changes begin rolling out.

For starters, most people will not notice a change immediately. That is because many health insurance policies offered through employers have varying coverage years. Some plans may not renew until January 1st, others may begin in the 4th quarter, and so on. That means if you’re already in the middle of a policy year you likely won’t notice many changes to premiums and some coverage until you enter your employer’s open enrollment period and elect new coverage. Since open enrollment occurs in the fall for many employers, it’s a good idea to brush up on the changes now so you know what your options are this fall.

Other key changes:

  • Dependent Coverage: Health care reform has made significant changes in terms of dependents. Employers will now have to provide additional coverage for dependents of workers up to age 26. Your dependent can’t qualify for coverage with their own employer, but if they don’t have available coverage you can add them to your policy until they are age 26 or until they can receive coverage on their own. Some states have already had this in place and a few even go to ages 28 or 29, but going forward this will be available to almost everyone. It comes at a cost, but it is better than the alternative of having an older uninsured dependent.
  • Children and Pre-existing Conditions: One of the dirty tricks in the health insurance industry was the ability for insurers to deny coverage on children for pre-existing conditions. With the new changes taking effect insurers can’t drop a child’s coverage for a pre-existing condition up to age 19. This change is coming for adults, too, but not until 2014. The same is true for insurers who would drop coverage when a customer gets sick or go back and look for errors in application paperwork that could nullify coverage. This is good news for everybody.
  • Doctor Choice: Going forward, plans must allow pediatricians and OB/GYN to get primary physician status. This eliminates the need to get pre-authorization from the insurer or obtain a doctor’s referral to see one of these physicians.
  • Better Appeals Process: If you’ve ever had to appeal a claim or correct an error you understand how frustrating this can be. The changes being made require insurers to establish a new appeal process for claims to make it easier for customers. Not only that, but they can no longer refuse to pay claims while you have something under appeal. You will now have your claims paid even if something is being appealed so you don’t have to worry about continuing to receive treatment.
  • No Lifetime Limits: While not something you hope to ever use, you may notice that your health insurance has maximum lifetime dollar limit. It may be in the millions of dollars, but if you ever need expensive treatment over a long period of time it’s easy to reach that limit. Now, insurers can no longer impose lifetime dollar limits on essential benefits, including hospital stays.
  • Free Preventive Care: All new plans must cover many common preventive services. This includes mammograms and colonoscopies. In addition, insurers are not allowed to charge a deductible or co-pay on these services. This won’t apply if you keep your existing plan or won’t apply until your group plan gets changed.

Author: Jeremy Vohwinkle

My name is Jeremy Vohwinkle, and I’ve spent a number of years working in the finance industry providing financial advice to regular investors and those participating in employer-sponsored retirement plans.

4 comments
Stu @ Pennywise2Pennyworth
Stu @ Pennywise2Pennyworth

Thank you for the information Jeremy. I know I didn't know about these changes. I am pleasantly surprised that there will be free preventative care. Its a great first step to a coherent and fair health care package for every American.

Melissa @ PureFi
Melissa @ PureFi

Thanks for this helpful post on the changes happening today. These are definite improvements from the perspective of an employee who has health coverage.

My biggest health strategy is to eat lots of fruits and veggies, not carry extra weight, and exercise regularly. While there are always accidents and things we can't control (for this reason health insurance is essential), a TON of health problems can be avoided by better lifestyle choices. Not always easy or fun, but better than ending up in the hospital or with a chronic illness.

Briana @ GBR
Briana @ GBR

Hey Jeremy, do you know when the dependent coverage change goes into effect?

Jeremy
Jeremy

You mean the ability to keep dependents on up to age 26? That's something that takes effect today, but I believe it's one of those items where you have to wait until you renew your plan and it isn't automatically retroactive. So, if you have an open enrollment period coming up, that should be an option to add your dependent. But if you just recently renewed a policy I don't think you can add them until the new enrollment period or qualifying life changes that allows you to update your coverage election.

Don't quote me on that, but that's how I understand it.