Obamacare News Blog

Health Care Reform Explained

September 23, 2010 marked a new day for American consumers in our health care system. On this day, a series of new rights, benefits, and protections under the Affordable Care Act brought an end to some of the worst abuses of the insurance industry. Combined, these new provisions put consumers, not insurance companies, in charge of their health care. Below is a brief summary of the new restrictions for insurance companies and new rights for consumers that are currently in effect:

Insurers Are No Longer Able To:

• Deny coverage to kids with pre-existing conditions. Health plans cannot limit or deny benefits, or deny coverage,  to children under 19 simply because they have a pre-existing condition ( like asthma).
• Put lifetime maximums on benefits. Health plans can no longer put a lifetime dollar limit on the benefits of people with costly health conditions, such as cancer
• Cancel your policy without proving fraud. Health plans can’t retroactively cancel your insurance coverage, solely because you or your employer made an honest mistake on your insurance application.
• Deny claims without a chance for appeal. In new health plans, you now have the right to contest an insurer’s decision to deny payment for a test or treatment. This also includes an external appeal to an independent reviewer.

Consumers in New Health Plans Are Able to:

• Receive preventive services free of charge. New health plans must give you access to recommended preventive services, such as screenings, vaccinations, and counseling, without any out-of-pocket costs to you.
• Keep young adults on a parent’s plan until age 26. If your health plan covers children, you can now add or keep your kids on your insurance policy until they turn 26, if they don’t receive coverage through work.
• Choose a primary care doctor, ob/gyn and pediatrician. New health plans must let you choose a primary care doctor or pediatrician of your preference from your health plan’s provider network. They are also required to let you see an OB-GYN, without needing a referral from another doctor.
• Use the nearest emergency room without penalty. New health plans can’t require you to get prior approval to receive ER services from a provider or hospital outside your plan’s network. Moreover, they cannot require higher copayments or co-insurance for out-of-network emergency room services.