Health-care reform roundup

There is so much talk these days about what will (or what might) happen in the future with national health-care reform legislation that it’s easy to overlook what already has happened.

No copay for your last mammogram or the kids’ most recent immunizations? That’s the
Patient Protection and Affordable Care Act. Lower prices for Medicare prescriptions? Again, that’s health-care reform.

Here is a rundown of provisions already in place that are likely to affect consumers:

By Richard Cox
Communications Director,
Health District of Northern Larimer County

No copays, deductibles or cost sharing for preventive care with some health plans

Unless a private health plan is considered to be “grandfathered” (it was in existence on March 23, 2010, and hasn’t changed significantly since then), it must now cover many preventive services at no cost to the consumer, including common immunizations and screenings for heart disease, cancer, depression and other serious chronic conditions. No-cost preventive services are also available for people enrolled in traditional Medicare.

Reduced prescription pricing for Medicare Part D

Enrollees in Medicare Part D now pay just 50 percent of the cost of brand-name drugs and get a 7 percent discount on generic medications. The revised pricing, which took effect this year, is part of an ongoing series of changes that will continue to reduce out-of-pocket expenses for enrollees in the Medicare prescription drug plan. Next year, the discount on generic medications increases to 14 percent. In another change to both Medicare Part D and Medicare Advantage, the annual enrollment period moved up to Oct. 15, alleviating some of the end-of-year confusion caused by the previous enrollment schedule.

Young adults can stay on parents’ health insurance until age 26

Qualifying young adults up to age 26 can remain on their parents’ health insurance as long as they are not eligible for another employer-sponsored health plan. The National Center for Health Statistics estimates that nationwide an additional 900,000 adults ages 19 to 25 gained health insurance during the first year this provision was in effect.

No lifetime limits on coverage

Individual and group health plans may no longer impose lifetime limits on coverage. These are dollar limits on coverage provided during a person’s lifetime. While they may seem high and often are never reached, a catastrophic injury or chronic illness easily could max out a person’s lifetime coverage. Insurers also are barred from imposing annual coverage limits on a number of “essential health benefits,” including emergency services, hospitalization and preventive services.

Children with pre-existing conditions cannot be denied coverage

Children with pre-existing conditions may not be excluded from their parents’ health plan. Insurers also are not allowed to insure a child but deny treatment for that child’s pre-existing condition. In 2014, these same provisions will extend to adults with pre-existing conditions. A state law passed earlier this year requires all insurance carriers that offer individual health plans for adults in Colorado to also offer at least one child-only plan. Open enrollment for these plans is in January and August.

Health plan for people with pre-existing conditions

People unable to get health insurance because of a pre-existing condition may be able to get coverage through GettingUSCovered, a comprehensive new plan for Colorado residents who have a pre-existing medical condition and have been uninsured for at least six months. It’s one of the temporary high-risk pools established as part of the past year’s health-care reform legislation.

Coverage begins immediately after a person is accepted into the plan. Once enrolled, participants have coverage for primary and specialty care, mental-health services and prescriptions. If you have been uninsured for less than six months, you may be able to get coverage from an existing program, CoverColorado. If you’ve been uninsured for more than 90 days, however, you would have a waiting period before your pre-existing condition is covered.