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Health Insurance Reform: What does it mean for me?

La Reforma de Seguros de Salud: ¿Qué significa para mí?

Health Care

If you like your insurance and your doctor, you can keep both of them. And, you will have more options and new protections against insurance company abuses. Bottom line: health insurance reform will save you money because lowering administrative costs and creating real competition will lower premiums.

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  • IMMEDIATE BENEFITS

      1. Small businesses can immediately take advantage of a tax credit of up to 35% of premiums to help provide their employees coverage
      2. Medicare beneficiaries who hit the donut hole in 2010 will receive a $250 rebate check this year
      3. All Medicare beneficiaries will receive free annual checkups and free preventive services and screenings like mammograms and colonoscopies
      4. All early retirees aged 55-64 can take advantage of a temporary re-insurance program to offset the cost of health claims for employers that provide health benefits for retirees
      5. Insurance companies are now prohibited from denying coverage or dropping individuals when they get sick or make a claim
      6. Children with pre-existing conditions will have access to coverage through the high-risk pools, and insurance companies can no longer drop coverage for children based on pre-existing conditions
      7. Insurance companies are now prohibited from placing lifetime caps on coverage
      8. Insurance companies are now prohibited from overly restrictive yearly caps on coverage
      9. All new private plans must provide free preventive care like mammograms and colonoscopies
      10. From now on, all consumers will have the opportunity to directly appeal insurance industry coverage decisions by their health insurance plan
      11. Insurance companies must spend at least 80% of your premium dollars on medical services, not CEO salaries, marketing or administrative services - and must send consumers rebates for any non-compliance
      12. Americans who are uninsured due to a pre-existing condition can immediately receive quality coverage
      13. Insurance companies must extend their parents’ health insurance coverage to young adults until they reach the age of 26
      14. Health insurance reform will invest in community health centers to allow them to nearly double the number of patients they see over the next five years
      15. Health insurance reform invests in new training programs for nurses, public health officials and primary care physicians to increase the number of care givers
      16. Insurance companies are now prohibited from discriminating based on an individual’s salary
  • FOR FAMILIES

      You will likely see lower premiums, a result of lowered administrative costs and greater competition between insurance companies. You will have more options, more benefits, and more protections against insurance company abuses.

      Health insurance reform eliminates the hidden tax your family currently pays due to uncompensated care from the uninsured. On average, that increases family premiums over $1,100 a year. Also, insurance companies now have limits on what they can require families to pay out-of-pocket in co-pays and deductibles -- and lifetime caps on benefits are prohibited.

      Your family will be able to access the health insurance Exchange, where you can do a side-by-side comparison of all the different health care coverage options. This way you can easily find the best quality, least expensive choice which will inject much needed competition into the healthcare marketplace and bring down costs.

      Children with pre-existing conditions WILL get health insurance coverage. If your child currently has coverage, the insurance company can’t deny them care. So if he or she has asthma, no insurance company can refuse to cover his or her inhaler. And if your child DOESN’T have insurance and gets denied because of a pre-existing condition, they can join the high-risk pool in their state. Those pools start within the next 90 days, so your child will have a number of options for quality, affordable coverage.

      If you make less than $200,000 a year individually or less than $250,000 as a couple your taxes will not increase. If you are a family of four who makes $88,000, you will be eligible for tax credits to help pay for your premiums and slash our out-of-pocket costs for medical coverage.

  • FOR SMALL BUSINESSES

      For small business owners, health insurance reform provides tens of billions of dollars in tax credits that will help employers afford coverage for their employees. Additionally, employees can get tax credits to help them afford coverage.

      Reform means more stability for small business owners, who will no longer be at risk of their insurance company raising premiums up to 200% because employees get sick, older, or because they hired a woman. If you employ 50 workers or less, you are exempt from all health insurance responsibility requirements. In fact, you are most likely eligible for tax credits of up to 35% of premiums to help you provide coverage to your employees.

  • IF YOU'RE ON MEDICARE

      Guaranteed Medicare benefits will not be touched.

      If you like your doctor, you can still see him/her. Or, you can see different doctors if you want to -- it's up to you. And you now have access to free annual checkups and free preventive care such as mammograms and colonoscopies.

      Health insurance reform will lower your prescription drug costs by offering 50% discounts on brand-name and biologic drugs as well as reducing the prescription drug donut hole. Also, if you hit the donut hole this year, you can expect a $250 rebate check in the mail.

      Additionally, reform cuts red tape by allowing your doctors, nurses, specialists, and primary care physicians to coordinate your care more effectively. This will help improve the quality of care, save money, reduce avoidable readmissions, and prevent hospital acquired infections that occur too much.

  • IF YOU HAVE NO HEALTH INSURANCE COVERAGE NOW

      There are three ways health insurance reform helps you afford coverage:

      1. tax credits to help you afford it
      2. bans insurance companies from price gouging you simply because you don’t currently have insurance or have a pre-existing condition
      3. prohibits insurance companies from denying you coverage

      Insurance companies will no longer be allowed to deny coverage because you have diabetes, cancer or any other pre-existing condition. In fact, if you have a pre-existing condition and are uninsured, you are immediately eligible for coverage.

      If your employer doesn't provide insurance, you could be eligible for tax credits to help you buy quality, affordable coverage. If you buy your own individual insurance, your premiums are expected to drop anywhere from 14 to 20%. Additionally, you could take advantage of new tax credits that can help reduce your premiums by an average of 60%.

      For the first time in American history, there is a limit on how much the insurance company can make you pay. In addition to historic protections against insurance company abuses, all insurance plans must have a simple appeals process to challenge coverage decisions by your insurance company. If you disagree with their decision, you can bring it before an independent appeals process.

  • IF YOU RETIRED EARLY

      For too long, insurance companies were able to take advantage of early retirees because they were not employed and too young for Medicare. Health insurance reform prohibits outrageous age ratings for premiums. Now there are limits on these insurance company abuses!

      You could benefit from $5 billion in financial assistance to employers to help them provide early retiree coverage. This will make it easier for employers to provide early retirees coverage and will provide premium relief of up to $1,200 for every family.

      You will be able to access the Exchange where you can do a side-by-side comparison of all the different health care coverage options. This way you can easily find the best quality, least expensive choice which will inject much needed competition into the healthcare marketplace to bring down costs for you and your family.

  • IF YOU RECENTLY GRADUATED FROM COLLEGE

      You are allowed to stay on your parents’ health care plan until you turn 26. This will help cover many of the one in three young adults who are uninsured. Under health insurance reform, you will always have access to quality, affordable health insurance choices regardless of how their lives change.

  • IF YOU HAVE CANCER, DIABETES, OR OTHER PREEXISTING CONDITION

      Until now, insurance companies could deny coverage based on pre-existing conditions such as diabetes, cancer, asthma, heart burn, pregnancy, or even acne! Even domestic violence was counted as a pre-existing condition in some instances.

      However, insurance companies are no longer allowed to deny coverage based on a person’s medical history, including genetic information. In fact, if you have a pre-existing condition and are uninsured, you are immediately eligible for coverage in a brand new insurance pool.

  • IF YOU ARE A SERVICE MEMBER OR VETERAN

      VetsIf you are eligible for VA health care, you will remain eligible. If you have TRI-CARE or TRICARE for Life, there is no provision in the legislation that would increase co-payments, deductibles, or change eligibility requirements.

      If you have VA health care you can add or change to private insurance from the new healthcare marketplace – the Exchange. If you are uninsured, you can purchase quality, affordable health insurance on the Exchange as well.

  • BOTTOM LINE: REFORM HOLDS INSURANCE COMPANIES ACCOUNTABLE

      1. Insurance companies that spend too much on CEO salaries and marketing are required to send you a rebate check
      2. Insurance companies that engage in price gauging will be banned from offering plans in the Exchange
      3. Insurance companies must now be transparent and provide notice for all rate hikes, so you can easily shop around for less expensive coverage

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