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Affordable Care Act to Improve Health Care Access and Coverage

If you haven't been able to access or afford health care insurance in the past, help is on the way. Learn how new legislation may provide you with the coverage you need.

According to the U.S. Census Bureau and data it released in September 2009, the number of people without health insurance coverage rose from 45.7 million in 2007 to 46.3 million in 2008. This means that approximately 15% of the U.S. population, which hovers around 309 million, lacks coverage.

Being without coverage is a frightening proposition. People in these situations often wonder when an accident, injury or sickness may propel them into financial ruin or even if they'd be able to access care when the need surfaced. Moreover, these same individuals aren't receiving any preventive care to prohibit bigger, more expensive problems.

If you're among these statistics and if you haven't been able to qualify for, or afford, coverage in the past, help is on the way. On March 23, 2010, President Obama signed into law the Affordable Care Act, which calls for comprehensive health insurance reforms designed to lower health care costs, prevent costly illnesses, provide greater access to benefits, and improve the quality of care of the health care system in general. Those who benefit immediately include:

  • Those who haven't been able to buy insurance
  • Graduating students who have lost coverage
  • Parents of children with pre-existing conditions
  • Mature adults who've fallen into the Medicare prescription drug coverage gap

Changes resulting from the law are being implemented already, and more changes will come through 2014 and beyond. Here are some of the significant changes coming soon or already in force:

  • More Options: Regardless of medical history, anyone should be able to access health insurance and HealthCare.gov is a federal government website managed by the U.S. Department of Health & Human Services (HHS) that will help you find it. The site features an online tool to help identify private insurance options for individuals and families, as well as public programs. The site will eventually include pricing estimates from private insurance plans so you can compare options more efficiently. And if you can't afford it, you may quality for government assistance or subsidies. The site walks you through different questions to help identify the right coverage for you and your family.
  • Insurance for Young Adults: Starting as early as September 2010, if you're under the age of 26, you can be insured as a dependent on your parent's health insurance, as long as you can't get your own coverage through work and if your parent is covered by their employer. Previously, young adults faced high premiums that they may have been ill-equipped to afford; consequently, many young adults opted to go uninsured. Such worries no longer exist as parents can keep dependent children on their plans for longer periods.
  • No Exclusions for Pre-Existing Conditions: Beginning in September 2010, job-based and new individual plans cannot reject coverage to any child under age 19 based on a pre-existing condition, including a disability. The new law also introduces the Pre-Existing Condition Insurance Plan to make coverage available to those who've been denied by private insurance companies because of pre-existing conditions.
  • Free Preventive Services: Preventive care keeps Americans healthy, yet because of its costs, was out of reach for some. Reform legislation removes those barriers. If you have a new health insurance plan or policy beginning on or after September 23, 2010, then many preventive services must be covered without incurring any coinsurance or deductible payments. When services are delivered by a network provider, you may also gain easier access to preventive screenings and check-ups, such as well-baby and well-child visits for your dependents from birth to age 21, as well as many cancer or obesity screenings (e.g., annual mammograms for women over 40); blood pressure, cholesterol or diabetes tests; routine vaccines; flu and pneumonia shots; and more. Coverage depends upon your age and health plan type.
  • Help for Seniors: Changes will help strengthen Medicare's future by saving seniors money on prescription drugs and preventive services. For example, steps are being taken to help beneficiaries with high drug costs who have reached the prescription drug coverage gap known as the "donut hole." This occurs when seniors max out their drug benefits, and have to cover expenses out-of-pocket. Unable to afford expensive medications, some seniors quit their prescription regimens required for good health all together. To fill the gap, the federal government is issuing $250 tax-free rebate checks to eligible seniors. Additionally, some preventive care services (e.g., annual physicals, mammograms and certain colon cancer tests) will be free beginning in 2011. HHS developed a brochure that talks specifically about additional Medicare changes to come. You can also call 1-800-MEDICARE to learn more.
  • Tax Benefits: There are tax provisions associated with the new law, some of which take effect in 2010. For example, health coverage for an employee's children under 27 years of age is now generally tax-free to the employee. Also, starting in 2014, if your income is less than the equivalent of about $88,000 for a family of four today, and your job doesn't offer affordable coverage, you may get tax credits to help pay for insurance. Consult with a tax advisor for more details.

What's to Come

Stay tuned for updates about upcoming reforms. One place you might want to bookmark for future reference is the HHS' health care website. The site breaks down the new law and provides links to information such as state-specific private insurance plans, public programs and community services that may be available to you beginning today.

Also, the healthcare.gov site features a timeline that visually displays projected changes. One anticipated development is the creation of a health care exchange, expected in 2014, to help individuals purchase insurance through an online marketplace if it's not offered by their employers.

The reforms issued through this new legislation are a step in the right direction to repairing a broken U.S. health care system as long as they can fulfill their promised benefits. The best thing you can do as a consumer is to stay informed and take advantage of the newly designed and reformed programs that can help you maintain good health.

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