The first phase of a vast overhaul of the American healthcare system begins this week, meaning a changed landscape for both insurers and the insured.
Some health insurance companies are already moving to skirt new regulations covering child-only plans, scrapping their versions before a rule requiring them to cover pre-existing conditions goes into effect.
The companies, which include big-name players WellPoint, Cigna and CoventryOne, will keep the child-only policies they’re already carrying and offer pre-existing condition coverage to new family polices, according to the Washington Post.
For insurance purchasers too, a raft changes will begin taking shape this week. Here’s a look at what consumers will see as the autumn open enrollment period approaches (some changes won’t be felt until Jan. 1, 2011, when new healthcare plans kick in):
- No lifetime limits on coverage. If you sign up for a new plan after Sept. 23, you can keep it for life.
- Adult child coverage extended. Parents can keep their children on family plans until the kids hit 26.
- Significant changes trigger new plan status. If employers make significant changes to healthcare plans, i.e. raise employee premiums or cut benefits, the plan is deemed new and falls under the new guidelines.
- Free preventive services.
Preventive care such as breast cancer screenings and cholesterol tests will not be subject to deductibles or co-pays.
- Easier OB/GYN and pediatric visits.
Prior authorizations for visits to obstetricians and pediatricians will no longer be required.
- Free immunizations.
- Small business tax credits. Companies with 25 of fewer employees, who make $50,000 on average, will get a 35 percent tax break on the cost of premiums. The credit is slated to rise to 50 percent in 2014.
- Fees for larger businesses. Companies of 50 employees and up, with at least one employee enrolled in a subsidized plan, will have to pay $2,000 per full-time employee starting in 2014 (with a 30-employee exemption).
- Rescission ban. Insurers will no longer be able to cancel individual coverage if a customer gets sick.
- Pre-existing condition changes for children and adults. Insurers will no longer be able to bar children with pre-existing conditions as of this fall; the same rule goes into effect for adults in 2014.
- Subsidized care for low-income families. Families and individuals with income levels of 400 percent of the poverty line will qualify for subsidized coverage.
- Mandatory coverage rules. By 2014 most people will be required to have health insurance.
- Medicare wins, Medicare Advantage loses. Basic Medicare benefits are set to grow, but Medicare Advantage plans — privately administered Medicare plans — could see benefits shrink.