Health

What You Need to Know About Tomorrow’s New Health Regulations

Tomorrow, the six month anniversary of the new health care law, a litany of mandated health insurance changes go into effect. Thanks to CNNMoney.com, here’s what you need to know:

If you get insurance through your boss: Many people who are insured through work won’t notice immediate changes to their health plans until their health plans renew, which is tied to companies’ open enrollment periods. Health plans offered through large employers usually get renewed on January 1.

But the mandates could kick in sooner for health plans sold to new entities or individuals after September 23.

Here are some key changes coming into effect:

  • Coverage expansion for adult dependents until age 26. Employers will have to provide coverage for dependents of workers who don’t have access to other employer-based health care coverage ’till age 26. Some states already mandate this coverage until age 28 or 29.
  • Children no longer denied coverage for pre-existing conditions: Insurance plans can’t deny coverage due to a pre-existing condition to children under age 19. For adults, the same provision goes into effect in 2014.
  • Prohibit insurers from rescinding coverage: It‘s illegal for insurers to drop a customer when they become sick or search for an error on a customer’s insurance application and then deny payment for service when the person gets sick.
  • Free Preventive Care: All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance. If individuals keep their existing plans or if a group plan doesn’t make major changes, the provisions won’t kick in until the plans get changed.
  • No lifetime limits on coverage: Insurers no longer can impose lifetime dollar limits on essential benefits, like hospital stays or expensive treatments.
  • Unrestricted doctor choice: Plans must allow pediatricians and obstetrician/gynecologists to get primary care physician status. This eliminates the requirement for patients to get prior-authorization from their insurer or a doctor’s referral to see a pediatrician or OB/GYN.
  • Level charges for emergency services: Insurers must remove prior authorizations for ER services. Also, insurers can’t charge higher co-payments or co-insurance for out-of-network ER providers.
  • Patient-friendly appeals process: Insurers will have to establish new internal and external appeals processes for claims. This means that while a claim is under appeal, your insurer has to continue to pay your claims, and continue paying for subsequent treatment, until the matter is resolved.

Small business impact: The changes that kick in on Sept. 23 also apply to small businesses with 50 employees or more that already offered insurance coverage prior to reform.

Companies that didn’t offer coverage pre-reform and have no more than 25 workers will be given incentives such as tax credits and grants to encourage them to offer insurance coverage, said Dorothy Miraglia, director of benefits with AlphaStaff, a firm that manages employee benefits programs for small businesses.

If you buy insurance yourself: For consumers who buy health insurance directly from insurers, some of the same key changes go into effect this month.

Most importantly, insurers can’t drop you when you get sick or because you made a mistake on your coverage application. Insurers also can’t set annual or lifetime limits.

If you have children under age 26, you can insure them if your policy allows for dependent coverage. Individual plans can’t deny or exclude coverage to any child under age 19 for pre-existing conditions.

If you’re a senior citizen: If you have Medicare prescription drug coverage and are affected by the donut hole, this year you will get a one-time tax-free $250 rebate to help pay for prescriptions.

The prescription drug coverage gap that develops when Medicare stops paying for drug coverage and patients can’t afford to pay for drugs out-of-pocket is called the “donut hole.”

In 2011, if high prescription drug costs put you in the donut hole, you’ll get a 50% discount on covered brand-name drugs while you’re in the donut hole.

Also in 2011, Medicare will cover certain preventive services without charging you Medicare Part B (coverage for doctors’ services, outpatient care, home health services) coinsurance or deductible.

Comments (68)

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  • Mikee T
    Posted on September 22, 2010 at 11:10am

    I can’t wait for the IRS to try and tell me I have to pay for health insurance or I owe this much money…. I can’t wait to say @#@#ck off !!!!!!!!!!!!!!!!!

    The audacity of these people is what really brings my ire …..who the hell do they think they are ? This is America…….WE THE PEOPLE decide what is right for us….not the MARX brothers…..

    Report Post »  
    • JennFL
      Posted on September 22, 2010 at 1:20pm

      You probably won’t even be given the chance to tell anyone anything. They will probably just take it from you as they view it is their right to do so for the greater good.

      Report Post »  
    • american1st
      Posted on September 22, 2010 at 7:20pm

      remember remember
      come election November
      the nationalize heath care plot

      i see no reason
      this election season
      why we shouldn’t just vote out the lot

      Report Post » american1st  
    • Dyllon
      Posted on September 23, 2010 at 1:42am

      Who do you think has to pay if you get in an automobile accident randomly one day and you don’t have health insurance? Not the hospitals who are required to treat you but good ole Uncle Sam. I and the government are saying that it’s not right other people have to help you because of your decision to go uninsured.

      I’m not a constitutional expert, but the reason behind the measure is irrefutable fact whether or not it is constitutional.

      Report Post » Dyllon  
  • beckNcall
    Posted on September 22, 2010 at 11:01am

    I thought your doctor is REQUIRED BY LAW to hand your medical records over to the Government. Scary thought is the UN getting into your medical records? Imagine that? I‘m just sayin’ they have given the UN everything else…. IE Our water ways. Oh, you didn’t know that? HR3534 puts oceans and coasts under UN. This passed house now in Senate. Good idea to call your senator today.
    http://www.boogai.net/top-story/breaking-us-house-puts-oceans-coasts-under-un-senate-vote-will-seal-the-deal/

    Report Post » beckNcall  
  • broon
    Posted on September 22, 2010 at 10:55am

    Google the following folks !!!

    Salvare, Your Healthcare Alternative

    it will open your eyes to the possibilities

    Report Post »  
  • broon
    Posted on September 22, 2010 at 10:51am

    This story reminds me of a Mary Poppins song…
    Spoon Full of Sugar ” anyone ?
    Planned nudging toward the socialist medicine folks.
    All the “good” stuff comes first.
    – All kids covered
    – no recind
    – Free Boob & Butt exams
    That’s great… (How are we gonna pay for that stuff exactly ?)

    Then the bomb drops in 2014 after we’re all happy as clams with all this good stuff.
    Read UNIVERSAL COVERAGE by DAN PUTKOWSKI
    for fictional insight on what may come.

    Report Post »  
  • bryan69
    Posted on September 22, 2010 at 10:49am

    This is the, “Try a taste…” part of the drug deal. Don’t worry, everybody is doing it.
    Ever notice that the, “Every bodies” who are doing it are jobless, homeless, broke and failing?
    Kind of rings true with Healthcare States as well as drugs, booze and World of Warcraft.
    Oh, and one more thing. Most of those “Every Bodies” also end up in bad health.
    {World of Warcraft based on “South Park” Parody. I honestly don’t know if players fit this mold.}

    Report Post »  
  • Bobbie227
    Posted on September 22, 2010 at 10:44am

    Well, naturally, they are showing the “good” first!! But, is it really good? Personally, I do not think this is at all legal because the government does NOT have the right to force the people to buy anything! Not only that, the bill was not even passed legally!! This bill is further going to put people out of jobs. My doctor won’t even talk about this bill. That tells me plenty. I just hope and pray that people come out and vote all those that voted for this bill OUT OF OFFICE, and bring in some sane minds. We won’t get them all the first pass, but we can make a difference. For now, I WANT THE REPUBLICANS TO BE THE PARTY OF NO! I want them to REMAIN the party of NO until they have the majority in the House and hopefully, the Senate and can REFUSE to FUND this insanity! November 2010 is truly a BIG ELECTION folks, PLEASE VOTE!

    Report Post » Bobbie227  
  • truth or consequences
    Posted on September 22, 2010 at 10:43am

    Lets see what happens when doctors receive all their pay from the Gov. They are not going to like the compensation/responsibility ratio.
    Concepts must be looked at from the extreme ends of the possibilities.
    Term Limits Glenn!

    Report Post »  
  • CaptElaine
    Posted on September 22, 2010 at 10:41am

    NOTHING in life is FREE people… SOMEBODY (you, some other taxpayer) will PAY FOR THIS… got that!

    NOTHING in life is FREE…

    “The People who cast the votes don’t decide an election, the people who count the votes do. ” — Joseph Stalin

    Report Post » CaptElaine  
  • Jsor2112
    Posted on September 22, 2010 at 10:40am

    I think it’s more of a power grab then anything else, they are trying to control more and more aspects of our everyday lives.

    Report Post » Jsor2112  
  • AmerNDN10
    Posted on September 22, 2010 at 10:34am

    well, at least they brought out the good stuff first. One exception is the enablment of your children to depend on you for a long time to come (ie: be on mommy’s plan until your almost 30). I don’t agree with enabling adults to depend on their parents. What’s next? mommy pay sonnyboy’s way until she dies?
    sheesh

    Report Post » AmerNDN10  
  • AMERICANCITIZEN
    Posted on September 22, 2010 at 10:33am

    Obamacare will not do anything to help the average american. It will only cause more problems for hard working americans. Solutions that could have helped with skyrocketing premiums, were not even considered, because this was not about helping. Its about power and redistributing money.
    Tort reform, selling policies over state line, fraud Medicaid/Medicare , and last but not least Illegal Immigrants. All of these things effect our premiums and not one thing was addressed in Obamacare.
    Premiums will go up on the working American, Seniors will be left out, the only people that win are politiicans, poor, and illegals.
    Progressives do not want a middle class America, they only want a 2 class system, rich and poor, no middle class. This is about power nothing more!

    Report Post »  
  • megansmom
    Posted on September 22, 2010 at 10:15am

    All this good cost money.
    For example my sons both have just a major medical plan they buy for themselves with a high deductible that cost them like 60 bucks a month , They are both healthy and pay for their drs visits out of pocket which may be 2 times a year and have a list of the 4 dollar meds from walmart. They might spend 300 bucks a year above there plan cost now .
    Get the picture a little better?

    Report Post »  
  • Polwatcher
    Posted on September 22, 2010 at 10:12am

    The elderly, disabled, and anyone who will ever be in that position (which is everyone) better watch out. Obamacare is ONLY good for more Washington centralized power. It is an early death for everyone else.

    Report Post »  
  • NomoObama
    Posted on September 22, 2010 at 10:07am

    I employ under 50 employees and cant afford to pay health care for them. If I am forced to offer it, something will have to give. Either layoffs or reduced pay. Nothing is free folks.

    Report Post »  
  • viper316
    Posted on September 22, 2010 at 10:03am

    It kinda reminds me of Obama during the campaign – he sounded like he know what he was talking about and those who voted for him (I sure as hell didn’t) thought he was the greatest thing ever. Then you find out his true agenda and realize it’s a load of crap and it may cost you an arm and a leg [literally in some areas :-)].

    Report Post »  
  • waresite
    Posted on September 22, 2010 at 10:02am

    As a physician, I will not be practicing if Obamacare is fully implemented. As it is now it is a lose/lose situation dealing with medicare and medicaid. NEWSFLASH! Healthcare is NOT a right. the current healthcare plan being implemented is designed to over time force insurance companies out of business and guess what, when that happens whats left? Rationing, less technology, and poor access. People would be better off wth health savings accounts and a catostophic health insurance plan.

    Report Post » waresite  
  • EgoBrain
    Posted on September 22, 2010 at 10:01am

    And the Homer Simpsons will celebrate the little ‘perks.’

    Report Post » EgoBrain  
  • tobywil2
    Posted on September 22, 2010 at 9:52am

    Our President has a courageous plan to save both Social Security and Medicare – read on!

    The Social Security Trust Fund is almost bankrupt and the Medicare trust fund is bankrupt. The problem has been apparent for years but until now no one has advanced a plan to save these popular programs.

    At last, our President has the courage to propose a solution! It is so simple that one wonders why no one thought of it before. The solution?

    Enact a “Health Care Reform Bill” the severely rations health care to the elderly. This will save the Medicare Trust Fund and allow it to be used to reward the Presidents political cronies and provide health care for “deserving Illegal Aliens.”
    Deprived of medical care, the lifespan of the elderly will be reduced, depleting the number of recipients of the Social Security Trust Fund, saving that popular program.

    Both problems solved! Why did it take so long to find such a simple solution?

    Of course, the Congress and the President are exempted from the solution so they can perpetuate the problem.
    http://commonsense21c.com/

    Report Post » tobywil2  
  • JR in Dallas
    Posted on September 22, 2010 at 9:47am

    I agree this part of it sounds fine but unfortunately it is only the beginning and the parts that are coming in 2014 are going to be much, much worse….

    Report Post »  
  • senah
    Posted on September 22, 2010 at 9:47am

    Just wait until you see your new preimums. You’ll have a heart attack. But no worries, your covered.

    Report Post »  
    • jenk99
      Posted on September 22, 2010 at 3:01pm

      Our premiums went up 45%, I tried really hard not to throw up.

      Report Post »  
  • Tatum
    Posted on September 22, 2010 at 9:47am

    Nothing is FREE you fools who believe it is.

    Report Post »  
  • LukeAppling
    Posted on September 22, 2010 at 9:44am

    Many doctors in our area are retiring rather than confront the madhouse of Obamacare. As more of the unread details arrive we should remember who foisted this boondoggle on We The People, in the middle of the night: Kosmas, Gray, Nelson[all of them], Pelosi, Boxer, McCain, Graham, Reid, Schumer, Frank, Waters, Rangel, Durbin, Emanuel, Axelrod, Sebelious, Browner, basically every democrat and especially Obama. All of these sleazy people who “rammed this down our throats”, to quote Trumka AFL/CIO Chief, while laughing at us, must be punished by being voted out of office. If we reward these people we will only get more of them and , like rats, the more there are the more difficult life is for honest hardworking taxpayers, not those who receive everything and contribute nothing.

    Report Post »  
    • heidi586
      Posted on September 22, 2010 at 10:06am

      My GYN is retiring…he is only in his 50′s and his comment was – “I don’t feel like dealing with everything…I‘ve worked hard and it’s just not worth it anymore.” Sad thing is, he is an excellent doctor and the type of doctor who gives that extra 110%….the type of doctor needed in every office.

      Report Post » heidi586  
    • perks
      Posted on September 22, 2010 at 10:33am

      I agree with everything you say… Except McCain didnt vote for this… Hes republican… Not that anyone notices that most of the time… But as I say, he didnt vote for this one

      Report Post »  
  • Alvin691
    Posted on September 22, 2010 at 9:40am

    We were just notified that our employer will be dropping one of our plans (the one I have) because it will be too expensive to maintain.

    Report Post »  
  • evanchristopher
    Posted on September 22, 2010 at 9:32am

    I don’t understand, this all sounds good…

    Report Post »  
    • Anonimouse
      Posted on September 22, 2010 at 9:37am

      It always sounds good until you get the bill.

       
    • vjustice
      Posted on September 22, 2010 at 9:47am

      I agree… the small summary of a 1200 page plus (or was this the 2K plus?) bill does sound pretty good, but the devil is in the details. One example…this bill will kill my husband. He has stage 4 kidney cancer, and the one med that holds back the rampage of this invader will NOT be covered because they consider it 1)too expensive and 2)not widely enough used… check out what it means when the bill says it will help or provide “covered brand name drugs”. Drugs like Sutent don’t count…. and that is just ONE detail of this monstrosity….

       
    • Vindex
      Posted on September 22, 2010 at 10:00am

      Exactly, You don’t understand. Not to be cynical but consider the source–CNN. Take, for example, the bullet point, “Unrestricted Doctor Choice”. All this means is that the primary care designation applies to Pediatricians and Ob/Gyns. It does not mean you have an Unrestricted Doctor Choice–You can choose the Doctor in your plan–and you think the MDs aren’t getting out of this system?? What we will have, eventually if this monster is not repealed, is a 2 tier system where those with cash will pay and receive prompt medical care and those with insurance will have a nice insurance policy and long waits. This is just what many other Countries have. That is until the whole thing blows up and everyone clamors for the government to “do something”–that is when we get our single payer, British type system that Obama and Berwick so desire.

      Report Post »  
    • CoFX
      Posted on September 22, 2010 at 10:09am

      Exactly. Premiums are going to skyrocket. Insurance companies are not going to generously pay for all these extra “free” services – they will pass the costs on to you. Let’s not forget the hundereds of thousands that will get free healthcare that never had it before, and will have all the free preventative care they want. This will overburden the system, raise premiums for everyone else even further, and make it harder for you to get an appointment to see a doctor for something that may be a serious health issue.

      Oh, wait. Obama said insurance wasn’t going to cost more. My mistake.

      Report Post » Rogue  
    • Comeandtakeit
      Posted on September 22, 2010 at 10:20am

      If they can’t charge you a co-pay for certain preventive services such as mammograms and colonoscopies do you REALLY think you are getting those services for Free? And why should you? As a small business man do I want my clients being told by the government that I owe them free services because some bureaucrat thought it would be fair?

      Report Post » Comeandtakeit  
    • Joe Potus
      Posted on September 22, 2010 at 11:09am

      Mmmmmmm… Look never people do at their PAYCHECK. yeaaasss. Never see they the dark side of paycheck deduction.
      Dude, are you serious that you think this is GOOD? Did you catch the whole “tied to companies’ open enrollment periods”????
      As yoda says: “mmmmm..you will,…you will”

      Report Post » Joe Potus  
    • John W
      Posted on September 22, 2010 at 11:41am

      it may sound good but it is a give away and your taxes will pay for it my insurance has already gone up and they say to cover cost to the ins. co.

      Report Post » John W  
    • 30moves
      Posted on September 22, 2010 at 12:09pm

      It is not a free-market approach – the government is forcing insurance companies to provide coverage for services for free. They are stealing money from the insurance companies. Which only have about a 5% profit margin. He demonized them in order to appeal to people’s emotions. Yes, insurance companies are a pain to deal with sometimes but just try to complain to a government health service.

      Could they go to McDonalds and demand that from now on they give away Quarter Pounders?

      This makes me sick. But I won’t go to the doctor. :)

      Report Post »  
    • tommee
      Posted on September 22, 2010 at 9:20pm

      I like it !

      Report Post »  
  • Anonimouse
    Posted on September 22, 2010 at 9:30am

    Have you all notified your doctors that you don’t want your medical records released to the government for their national database?

     
    • tobywil2
      Posted on September 22, 2010 at 9:50am

      Haven‘t seen a Doctor since 1984 and I don’t remember the guy’s name. http://commonsense21c.com/

      Report Post » tobywil2  
    • MJ1025
      Posted on September 22, 2010 at 11:35am

      We have can opt out of that?

      Report Post » MJ1025  
    • Anonimouse
      Posted on September 22, 2010 at 12:50pm

      MJ, yes, it’s currently legal to opt out. Who knows when they’ll try to take that away too? But if we are successful at repealing all this, they’ll still be in possession of our private information. I have no intention of giving up ANY right without doing all I can to make their lives miserable over it. Lets not be sheep here. It’s just one of the many ways we can fight back.

      Report Post »  
    • terryp
      Posted on September 22, 2010 at 10:59pm

      I wasn’t aware one could opt out of the medical records data base. Please explain. Thanks.

      Report Post »  
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