Assuming you haven’t been living in a cave for the past several years, you know that we now have the Affordable Care Act of 2010 or what’s often called Obamacare. You probably also know that its purpose is to help people who are currently uninsured get health insurance at a reasonable cost. But what you may not know is that the Act’s many provisions have also changed health insurance for many Americans who are already covered. In fact, Obamacare has resulted in seven big reforms that could help you get better health care.
If you have a pre-existing condition
In the past if you had a pre-existing health condition, you might find it impossible to get health insurance. And if you were able to get it, the insurer could charge you very high premiums or exclude some specific benefits. Roughly 220,000 Americans were able to get coverage through expensive pools for “high risk” people but it was estimated that roughly 25 million Americans with pre-existing conditions were uninsured. Today, no insurance company can make you pay more or refuse to cover you because of your health or a pre-existing condition. So, if you were uninsured because of a pre-existing condition or have been in a “high risk” pool, you can now get healthcare insurance and at reasonable cost.
In the past, many Americans were unable to get preventive care such as annual physicals and wellness programs. These were benefits enjoyed mostly by people who worked for very large employers who had large insurers. Now, all health plans must include a wide number of preventive treatments and services. So if you need a colonoscopy or a mammogram, they’re basically free today.
Until 2012, kids 18 to 21 could no longer be covered on their parents’ insurance – unless they were disabled or full-time students. Some young adults were able to get coverage through their employers but 40% of those between the ages of 19 and 25 were uninsured. However, for health insurance policies written since 2010, a child that’s younger than 26 can either return to or stay on dad’s or mom’s insurance plan – even if the child is married, financially independent, not living at home or eligible for coverage through his or her employer. For that matter, some healthcare policies now even include maternity benefits for young women who are still dependents. Unfortunately, this is more of a help to middle- and upper class children, as their parents needed to be insured. In comparison, low-income people are generally not in this situation.
If you would like to know more about how Obamacare benefits young people, watch this video.
Annual and lifetime limits
If you’re not aware of this, 80% of our healthcare costs are consumed by 20% of our population? As you might guess, these are older Americans. In the past, health insurance companies protected themselves against this by putting limits on the amount of money they would pay for claims annually or over the lifetime of the policy. While the largest percentage of people would never run into these limits, there were those who did and it could have crushing consequences – both in terms of their finances and their health. This is no longer true as Obamacare prohibits lifetime and annual limits at least for fundamental health benefits on all healthcare plans beginning next year. Unfortunately, some insurance companies have already found a way to beat this. Since the law only specifies a limit on dollars some insurance companies have just replaced these with benefit limits such as “just 10 days in the hospital a year” or “X number of doctor visits annually.”
Cancellation of coverage
In the past if you made a mistake on your application for insurance, the company could cancel your policy and even try to make you to pay back whatever money you had received for your claims. This practice was not widespread but some insurance companies did use this “to weed out people that became sick.” But this, too, is no longer the case. Obamacare makes it illegal for insurance companies to cancel your policy because you didn’t include some relevant details of your history or because of a whim. Today, there are only two legal reasons for canceling your coverage – incomplete or outright false information on your application or if you stop paying your premiums.
Before Obamacare, at least 7% of our health spending went towards administrative costs and other types of overhead, including what some people called flagrant profiting by the insurance companies. Today, insurance companies must submit any proposed rate increases of 10% or more for federal review. And if an insurance company spends less than 80% of its individual plan premiums on actual healthcare, it must refund the difference to policyholders. What this means is that ultimately your insurance company will either lower your premium or you’re going to get a sort of year-end “bonus.”
Before the Affordable Care Act, if you needed treatment for a serious illness that fell into an experimental or unproven area, your insurance company could refuse to pay it with no explanation as to why. Now, private insurers must inform you as to why it denied your claim and what you could do to challenge that decision. In the event your health insurance company continues to deny coverage after its own review, you can ask for an external review by an organization that has the ability to overturn the insurance company’s decision