How Has Health Care Reform Helped You?
Since its passage on March 23, 2010, health care reform has allowed Washington state families and small business owners the ability to benefit from better access, more choices, and a health care system that no longer works only for those who can afford it.
Some of these benefits include:
Expanding coverage options for young adults
Health plans are now required to allow parents to keep their children under age 26 without job-based coverage on their family’s coverage.
Making prescription drugs affordable for seniors
In 2010, Medicare beneficiaries who hit the coverage gap or “donut hole” in the
Medicare prescription drug benefit received a one-time $250 rebate. In 2011, Medicare beneficiaries began receiving a 50 percent discount on covered brand name drugs and coverage for 7 percent of the cost of generic drugs in the coverage gap. In 2012, Part D covers 14 percent of the cost of generic drugs in the coverage gap. Coverage for both brand name and generic drugs in the gap will continue to increase over time until 2020, when the coverage gap will be closed.
Covering preventive services with no deductible or co-pay
Insurance companies are now required to provide certain preventive services without requiring a copayment, co-insurance, or deductible to receive recommended preventive health services.
Removing lifetime limits on health benefits
The law bans insurance companies from imposing lifetime dollar limits on health
benefits. It also restricts the use of annual limits and bans them completely
Creating new coverage options for individuals with pre-existing conditions
The law created the Pre-Existing Condition Insurance Plan (PCIP) which provides health coverage for individuals who have been without health coverage for at least six months, have a pre-existing condition or have been denied health coverage because of a health condition. Moreover, beginning immediately, families seeking insurance for their children gained the right to
have the child’s pre-existing condition covered without any exclusion. In 2014,
this will expand to ensure all individuals will no longer be discriminated against based on a pre-existing condition.
Providing better value for yourpremium dollar
Insurance companies must spend generally at least 80 percent of premium dollars on health care and quality improvements instead of overhead, executive salaries or marketing. If they do not, they must provide consumers a rebate or reduce premiums.
Scrutinizing unreasonable premium increases
Insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more.
Assistance for small business employers
The law provides employers who have small businesses with fewer than 25 employees and provide health insurance to their employees the ability to qualify for a tax credit of up to 35 percent (up to 25 percent for non-profits) to offset the cost of insurance. This credit will increase in 2014 to 50 percent (35 percent for non-profits).
Creating Affordable Insurance Exchanges
Beginning in 2014, Health insurance exchanges will be set up in each state to allow individuals and small businesses to compare health plans, get answers to questions, find out if they are eligible for tax credits for private insurance or health programs like the Children’s Health Insurance Program (CHIP), and enroll in a health plan that meets their needs.
Preventing illness and promoting health
The Prevention and Public Health Fund was created to support effective policies in Washington, its communities, and nationwide so that all Americans can lead longer, more productive lives.
Increasing support for community health centers
The law increases funding for community health centers in all 50 states, including the 223 existing community health centers in Washington.
Additional Critical Funding Thanks to Health Care Reform
So far, Washington has received more than $133.7 million from the Affordable Care Act.
Get Access to Health Insurance Coverage with No Waiting Period
If your answer is yes to both questions, you may be eligible for the Pre-existing Condition Insurance Plan – a new federal program for children and adults with pre-existing conditions who have been uninsured for at least six months – with no waiting period.
For more information and how to apply, go to the Pre-existing Condition Insurance Plan – Washington website or call toll-free 1-877-505-0514.
Helping Seniors Afford the Prescription Drugs they Need
With this law, seniors have seen substantial relief on the cost of their prescription medications. Here is some information that Washington state Medicare beneficiaries need to know about how the law will help them.
As stated above, those seniors who fell into the gap in coverage in 2010 received a $250 check this year to help offset the cost. These checks were mailed out on June 10, 2010. They were sent by a Medicare contractor in envelopes with the Department of Health and Human Service logo clearly displayed and with the contractor’s Wisconsin address as the return address. Additionally,in 2011, Medicare beneficiaries began receiving a 50 percent discount on covered brand name drugs and coverage for 7 percent of the cost of generic drugs in the coverage gap. In 2012, Part D covers 14 percent of the cost of generic drugs in the coverage gap. This coverage for both brand name and generic drugs in the gap will continue to increase over time until 2020, when the coverage gap will be closed.
If you have any questions regarding potential discounts and rebates, you should call Medicare's toll-free number 1-800 MEDICARE (1-800-633-4227).
User Friendly Website
HealthCare.gov was launched to help individuals have more control over their health care as informed and empowered consumers. It makes comparison shopping easier with a new insurance finder that allows users to answer a few basic questions and receive information about insurance options that could work for them. The site makes a system that thrived on complication and confusion easier to understand.
Links to Full Health Care Reform Law