How the Health Care Law Benefits You

The Affordable Care Act forces insurance companies to play by the rules, prohibiting them from dropping your coverage if you get sick, billing you into bankruptcy because of an annual or lifetime limit, or, soon, discriminating against anyone with a pre-existing condition.

All Americans will have the security of knowing that they don’t have to worry about losing coverage if they’re laid off or change jobs.  And insurance companies now have to cover your preventive care like mammograms and other cancer screenings. 

When key parts of the health care law take effect in 2014, there’ll be a new way for individuals, families and small businesses to get health insurance.  Whether you’re uninsured, or just want to explore new options, the Marketplace will give you more choice and control over your health insurance options.

Health reform is already making a difference by:

• Increasing Access to Affordable Care
• Making Care More Affordable
• Strengthening Medicare
• Holding Insurance Companies Accountable
• Laying the Foundation for 2014

Increasing Access to Affordable Care

Millions of Americans have gained new access to more affordable health coverage and care.

• Coverage for young adults: 3.1 million young adults who were uninsured have gained coverage by being able to stay on their parent’s health plan, giving their families peace of mind.
• Access to free preventive services: 71 million additional Americans now receive coverage through their private health insurance plan for many preventive services without cost sharing such as copays or deductibles. That means that more Americans will receive wellness visits, cancer screenings and other services that will help them get and stay healthy. Women can now get coverage— without cost-sharing—of even more preventive services they need.  Approximately 47 million women now have guaranteed access to additional preventive services without cost-sharing for policies renewing on or after August 1, 2012.
• Coverage for people with pre-existing conditions: Over 107,000 Americans with pre-existing conditions have gained coverage through the Pre-Existing Condition Insurance Plan. This temporary program makes health coverage available and more affordable for individuals who are uninsured and have been denied health insurance because of a pre-existing condition.
• Investing in primary care: The health care law invests in training and supporting thousands of new primary care doctors and nurses by providing bonus payments, scholarships and loan repayment, and new training opportunities.
• Community Health Centers: Community Health Centers improve the health of the nation and assure access to quality primary health care services at more than 8,900 service delivery sites around the country. Since the beginning of 2009, health centers have increased the total number of patients served on an annual basis by 3.1 million.

Making Care More Affordable

The health care law is bringing down health care costs and making sure health care dollars are spent wisely.

• 80/20 Rule: The health insurance companies of 76 million Americans now have to meet the 80/20 rule, or Medical Loss Ratio, where they must spend at least 80 cents of your premium dollar on your health care or improvements to care. If they fail to meet this standard, they must provide a rebate to their customers. Already, the 80/20 rule is helping deliver rebates worth $1.1 billion to nearly 13 million consumers – an average rebate of $151 per household.
• Reviewing premium increases: For the first time ever in every State, insurance companies must publicly justify any rate increase of 10% or more. And the law gives States new resources to review and block these premium hikes. To date, rate review has helped save an estimated $1 billion for Americans and 42 States have used their rate review grant funds to make the rate review process stronger and more transparent. Since this rule was implemented, the number of requests for insurance premium increases of 10% or more has dropped dramatically, from 75% to 14%. The average premium increase for all rates in 2012 was 30% below what it was in 2010 this slowdown has continued into 2013.
• Small business tax credits: Small businesses have long paid a higher price for health insurance – often 18% more than larger employers. Tax credits for small businesses will benefit an estimated two million workers who get their insurance from an estimated 360,000 small employers who received the credit in 2011. In 2014, small business owners will get more relief with tax credits and affordable insurance choices in the new competitive health insurance marketplace in every State.
• Supporting early retiree coverage: The Early Retiree Reinsurance Program (ERRP) has provided $5 billion in reinsurance payments to employers so they can continue to provide benefits to their retired workers who are not yet eligible for Medicare. This program has reduced premiums or cost sharing for at least 19 million early retirees, workers, their spouses, surviving spouses and dependents.

Strengthening Medicare

Nearly 50 million seniors and Americans with disabilities depend on Medicare every day. The health care law makes Medicare stronger and extends the life of the Medicare Trust Fund by eight years.

• Reducing prescription drug costs in Medicare: Over 6 million seniors and people with disabilities have saved more than $5.7 billion on prescription drugs thanks to the Affordable Care Act. These savings include a one-time $250 rebate check to seniors who fell into the prescription drug coverage gap known as the “donut hole” in 2010, and a 50% discount on brand-name drugs. Seniors in the “donut hole” have saved an average of $706. 
• Medicare preventive benefits: The Affordable Care Act makes many key preventive services available with no co-pay or deductible to help ensure that seniors don’t have to skip a potentially life-saving cancer screening because they can’t afford it. In 2012 alone, an estimated 34.1 million seniors received one or more free preventive services, including the new Annual Wellness Visit.
• Saving money for seniors: The average person with Medicare will save approximately $5,000 from 2010 to 2022, while those with high prescription drug costs will save much more – as much as $18,000 over the same period. This is especially good news for people with chronic conditions such as diabetes and high blood pressure who must take their medication every day for many years.
• Fighting fraud and saving taxpayer dollars: The health care law helps stop fraud with tougher screening procedures, stronger penalties, and new technology. In 2012, the government’s health care fraud prevention and enforcement efforts recovered a record $4.2 billion in taxpayer dollars from fraudsters. And for every dollar spent on health care-related fraud and abuse investigations in the last three years we recovered $7.90. Over the last four years, the administration’s enforcement efforts have recovered $14.9 billion. And in total since 1997, the Health Care Fraud and Abuse Control Program has returned more than $23 billion to the Medicare Trust Fund. Learn more about these efforts at StopMedicareFraud.gov.

Holding Insurance Companies Accountable

Under the law, patients have more rights and protections – and more security that their coverage will be there for them when they need it. For example:

• No more pre-existing condition denials for children: The parents of over 17.6 million children with pre-existing conditions no longer have to worry that their children will be denied coverage because of a pre-existing condition.
• No more lifetime dollar limits on coverage: 105 million Americans no longer have a lifetime dollar limit on essential health benefits. Annual dollar limits are set at increasingly higher amounts until January 1, 2014 when most plans issued or renewed are banned from having an annual dollar limit on coverage.
• Insurance companies can’t drop your coverage when you get sick: You no longer need to fear that your insurance company can rescind or take away coverage when they get sick because of an unintentional mistake on an application.
• No more coverage denials without appeal: Many Americans with private coverage now have the right to appeal an insurance company’s coverage decision and the Affordable Care Act provides you with information and assistance to give you more control over your health care decisions.
• Helping consumers understand their coverage: The Health Insurance Finder on HealthCare.gov gives you information about the health plan choices in your community. Starting in September 2012, health plans must provide you with clear, consistent and comparable information about their health plan benefits and coverage. The Summary of Benefits and Coverage forms will enable you to easily understand your health coverage and determine the best health insurance options for your family.

Laying the Foundation for 2014

Starting in 2014, the Health Insurance Marketplace will make it easy for you to compare qualified health plans, get answers to questions, find out if you are eligible for tax credits for private insurance or health programs like Medicaid and the Children’s Health Insurance Program (CHIP), and enroll in a health plan that meets your needs.

• Building the Health Insurance Marketplace: The Affordable Care Act gives States the resources and power to build and run their own Marketplace, sometimes called an Exchange. Forty-nine States, the District of Columbia, and four territories have, having received at total of nearly $3.6 billion in Exchange Grants.
• Ensuring Health Insurance Choices: The Affordable Care Act creates a new type of non-profit health insurer, called a Consumer Operated and Oriented Plan (CO-OP). These insurers are run by their members. CO-OPs are meant to offer consumer-friendly, affordable health insurance options to individuals and small businesses. To date, a total of 24 non-profits offering coverage in 24 states have been awarded over $1.9 billion.
• Banning the Worst Insurance Practices: Starting in 2014, the Affordable Care Act will prohibit health insurers from charging more or denying coverage to people because of pre-existing conditions. It will also make charging women more for health insurance a thing of the past.

(Source: healthcare.gov)