New health care rules take effect this week

The Atlanta Journal-Constitution

Thursday marks six months since President Barack Obama signed the Patient Protection and Affordable Care Act — the health care overhaul bill — into law, and some key provisions will be taking effect.

For employees with existing policies

If you have an employer-provided insurance plan, on or after its renewal date:

● Lifetime limits on coverage will be barred.

● Employees with family policies can opt for coverage of their grown children up to age 26 who cannot get their own employer-provided coverage. Currently, the cutoff is usually between ages 21 and 23. Be warned: Covering an additional person under this provision may cost more.

For employees with new policies

The above provisions will also apply to those who opt for new policies under employer-provided plans, or whose employers make significant changes in their plans, such as increasing employees’ share of the costs beyond a certain amount. In addition, those policy holders will:

● No longer have to make co-payments or pay deductibles for many kinds of preventive care, such as cancer screenings, immunizations and colonoscopies.

● Be able to see obstetricians and pediatricians without prior approval from an insurer.

For those who buy their own insurance

● Their insurers will be barred from denying coverage for children under age 19 because of pre-existing conditions.

● Insurers no longer will be able to use failure to report past health history as a reason to rescind coverage, except in cases of fraud. Some patients diagnosed with serious illnesses had reported having their coverage canceled because they had forgotten to list minor ailments experienced years earlier.

● Already, those who are denied coverage by private insurers because of a pre-existing health condition can get a government-sponsored policy. Be warned, however: Georgia’s plans have high deductibles and premiums.

● Annual limits on the amount of health spending covered by insurance will begin to be phased out.

For employers

● Some small businesses will be able to claim a tax credit up to 35 percent of the cost of premiums if they choose to offer health insurance to their employees. To qualify, they must have 25 or fewer full-time employees earning an average yearly salary of $50,000 or less.

● Businesses that provide coverage to early retirees can get federal subsidies.

For those on Medicare

● Discounts will be provided for beneficiaries in the so-called “doughnut hole” who must pay for their own prescriptions.

● No co-payment will be required for preventive care or an annual “wellness” visit.

● Over time, extra benefits under Medicare Advantage may vanish because the new law cuts subsidies to insurers who provide the plans.

Coming later

More provisions — including a blanket ban on denial of coverage for pre-existing conditions and the controversial requirement that everyone buy health insurance — are scheduled to take effect in 2014.

Bill Steiden

Sources: U.S. Department of Health and Human Services, Kaiser Health News, National Public Radio, Christian Science Monitor, PA Health Access Network