Cost Curve
There is still hard work ahead as consumers, medical providers, health plans and elected officials must come together to find ways to bend the cost curve.
Dependent Coverage
The law allows most young adults to remain on their parents' health plan until the age of 26. In the past, dependent coverage might have depended on the child's student or marital status. That is no longer the case.
Early Retirees
The law provides financial relief for employers so retirees who are 55 or older, but who are not yet eligible for Medicare, can get quality, affordable insurance.
Essential Benefits
A federal-level discussion will take place throughout much of 2011 in an effort to define the “essential health benefits” which must be included in benefit plans offered through the health insurance exchanges.
Grandfather Status
The law includes a “grandfathering” provision that generally allows individuals and employers to maintain their existing health insurance coverage so long as they were enrolled at the date of the law's enactment on March 23, 2010.
Guaranteed Coverage
The law requires insurance companies to provide what is called “guaranteed-issue” coverage, meaning that insurers cannot deny coverage based on past illnesses or current health conditions.
Medical Loss Ratio (MLR)
Known as medical loss ratio (MLR), health plans will be required to report in each state where it operates: total premiums earned; total reimbursement for clinical services (claims paid); total spending on quality improvement activities; and total spending on all other non-claims costs excluding federal and state taxes and fees.
Online Exchanges
Beginning Jan. 1, 2014, consumers – individuals and small businesses – will be able to purchase health insurance and access subsidies for which they might be eligible through exchanges.
Patient Protections
The law creates a series of new patient protections designed to assure you can purchase health insurance even if you have a pre-existing condition; that you will not lose your coverage if you become sick; that you can choose the doctors you want from a provider network; and that you can easily access emergency care when you are away from home.
Preventive Services
One goal of the law is to encourage more Americans to seek those preventive services which can lead to early detection and treatment of a variety of chronic diseases and other costly medical conditions.
Preventive Services for Women
Beginning with plan years on or after Aug. 1, 2012, services including well-woman visits, support for breastfeeding equipment, contraception and domestic violence screening will be covered without cost sharing (deductible, copays or co-insurance) in non-grandfathered health plans.
Provider Choices
Beginning at plan anniversaries on or after Sept. 23, 2010, all non-grandfathered health plans must offer new protections assuring that consumers can choose the primary care provider or pediatrician of their choice from their plan's provider network.
Tax Credit
Many small businesses and not-for-profit organizations providing health insurance to their employees will qualify for a special tax credit of up to 35% (25% for tax-exempt organizations).