The new system will provide the right care, from the right place, at the right time. We currently have job-based insurance, an increasingly hit-or-miss, inefficient and unreliable approach. The goal of reform is to create a comprehensive health coverage infrastructure that, like our interstate highways, works consistently and seamlessly for all.
Expanding coverage for the uninsured and underinsured will help alleviate health care challenges one manageable step at a time. To learn what the gradual changes to our system will look like for you and other members of our community, explore the Reform Reality timeline categories below.
- Insurance companies are no longer able to set lifetime limits or cancel policies as result of illness.
- Children can stay on their parents' plan until age 26.
- New plans must provide free preventive services and allow for appeals of coverage denial.
- Insurance companies will be required to spend 80-85 percent of premium dollars on medical services. If not, they must provide rebates to policyholders.
- States will be able to require insurance companies to justify premium increases.
- Insurers will be required to cover adults with pre-existing conditions.
- Annual coverage limits will be banned.
- Qualified individuals will be able to purchase subsidized coverage in the Exchange, a regulated marketplace of insurance options.
- Employers will be required to pay a 40 percent excise tax on high-cost insurance plans.
- Provided a $250 rebate to Medicare beneficiaries who reached the Part D coverage gap in 2010. This gap, known as "the donut hole," will be gradually closed through 2020.
- Seniors in the "donut hole" will receive a 50 percent discount on brand name drugs.
- Most preventive care and screenings, including annual check-ups, will be offered at no cost.
- The government will begin to cut subsidies to Medicare Advantage, which costs the government more than traditional Medicare. Seniors on these plans may face reduced benefits or higher costs. During the first 45 days or later, seniors will have the option of transitioning to traditional Medicare.
- The "donut hole" will fully close.
- States are required to keep children on Medicaid or CHIP until 2019 when some children will transition into the Exchange, a regulated marketplace of insurance options.
- States are given the option to cover parents and childless adults up to 133 percent of poverty and receive current federal matching contributions.
- Medicaid's physician reimbursement levels for specific primary care services will be increased, encouraging more doctors to accept Medicaid.
- Anyone with an income below 133 percent FPL will be eligible for Medicaid.
- States can decide to keep adults on Medicaid that are over 133 percent FPL or transition them to the Exchange.
No matter what state you live in, there are helpful resources to answer your questions about children’s health insurance programs. If you are living in Missouri, click here and if you are in Kansas click here.
- Each state has created a temporary high-risk pool for those with pre-existing conditions who have been uninsured for at least six months.
- A temporary re-insurance program for early retirees age 55-64 was instituted.
- A large expansion in funds to Community Health Centers means more access to health care for the uninsured.
- Uninsured children under age 26 are allowed to join a parent's plan.
- Individuals and families will be allowed to purchase health insurance in state-based Exchanges. Those earning up to 400 percent FPL ($88,200 for a family of four) will have access to subsidies on a sliding scale.
- A cap on out-of-pocket costs will be set at $5,950 for individuals and $11,900 for families. Lower caps will be set for lower-income families.
- Individuals and families under 133 percent FPL will be eligible for Medicaid.
- Most Americans will be required to buy health insurance or pay a penalty. Undocumented immigrants will not be allowed to purchase insurance in the Exchange.
- Those who are exempt, or under 30, will be able to purchase a catastrophic policy.
Source: PICO National Network