The Affordable Care Act (ACA), which became federal law in 2010, includes vital protections and benefits for Michigan residents. Some of these protections are being phased in, and some have already taken effect.
LESS WORRY FOR YOUNG ADULTS AND THEIR FAMILIES
Q: How does the Affordable Care Act help young adults?
A: Before the President signed the Affordable Care Act into law, many health plans and issuers could remove adult children from their parents’ policies because of their age, whether or not they were a student or where they lived. The Affordable Care Act requires plans and issuers that offer dependent coverage to make the coverage available until the adult child reaches the age of 26. Many parents and their children who worried about losing health insurance after they graduated from college no longer have to worry.
DEPENDENT COVERAGE UP TO AGE 26
Q: What plans are required to extend dependent coverage up to age 26?
A: The Affordable Care Act requires plans and issuers that offer dependent coverage to make the coverage available until a child reaches the age of 26. Both married and unmarried children qualify for this coverage. This rule applies to all plans in the individual market and to new employer plans. It also applies to existing employer plans unless the adult child has another offer of employer-based coverage (such as through his or her job). Beginning in 2014, children up to age 26 can stay on their parent’s employer plan even if they have another offer of coverage through an employer.
RANGE OF OPTIONS
Q: I’m a young adult under the age of 26 and I’m on my parents plan now, but I’m scheduled to lose coverage soon. How can I keep my health insurance?
A: You have a number of options. First, check with your insurance company. Private health insurance companies that cover the majority of Americans have volunteered to provide coverage for young adults losing coverage as a result of graduating from college or aging out of dependent coverage on a family policy. This stop-gap coverage, in many cases, is available now. Second, watch for open enrollment. Young adults may qualify for an open enrollment period to join their parents’ family plan or policy on or after September 23, 2010. Insurers and employers are required to provide notice for this special open enrollment period. Watch for it or ask about it. Finally, expect an offer of continued enrollment for plans that begin on or after September 23, 2010. Insurers and employers that sponsor health plans will inform young adults of continued eligibility for coverage until the age of 26. Young adults and their parents need not do anything but sign up and pay for this option.
Q: I’m under the age of 26, and I used to be on my parents’ plan, but I recently lost this coverage because I graduated from college. Can I get coverage?
A: Yes. Check with your insurance company to see if they will provide that coverage to you now. If not, watch for the special open enrollment period and sign up then.
Healthcare reform offers a long list of general benefits to consumers. Keep reading for a few examples.
GETTING MORE OUT OF YOUR HEALTHCARE COVERAGE
Q: How much of my dollars are actually going toward my care?
A: That’s a great question! Thanks to health reform, 80 cents out of every dollar in healthcare premiums must be paid out to for a policyholder’s medical care. If the full 80 percent is not paid out, the Affordable Care Act (ACA) stipulates that your insurance company must send you a refund check every year. Here in Michigan, Michigan Consumers for Healthcare have already made a difference on this front! When the state of Michigan asked for a waiver to divert more than $53 million in consumer rebates back to the insurance industry, our coalition members fought that ruling and won! Because of the Michigan Consumers for Healthcare members, a federal ruling denied the waiver request – meaning less of your healthcare dollars go to insurance industry salaries and bonuses. This rule is referred to as the “medical loss ratio” provision of the Affordable Care Act.
COMMUNITY HEALTH CENTERS
Q: How does the ACA help Community Health Centers?
A: Health reform will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 184 Community Health Centers in Michigan, but also support the construction of new centers.
CHOICE AND ACCESS
Q: Will Michigan consumers have more choices?
A: Yes. Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider!
AFFORDABLE INSURANCE FOR UNINSURED WITH PRE-EXISTING CONDITIONS
Q: What about pre-existing conditions.
A: $141 million federal dollars are available to Michigan to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the federal government will administer the program for those residents.
Q: What does the new law mean?
A: Insurance companies are no longer be able to place lifetime limits on the coverage they provide, ensuring that the 6 million Michigan residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.