Health & Fitness

How the new health care law could affect you

For Sharon Wilkinson and Rick Case, provisions of the health care overhaul taking effect this month are a blessing. For Beckie Avery, they're a pain in the pocketbook.

For Cindy Miles, they're a great idea — that comes too late.

The Patient Protection and Affordable Care Act ultimately is supposed to make health care more affordable and expand coverage to everyone. Its target date for that is 2014.

In the meantime, a number of rules become effective Thursday, six months after passage of the act.

Kansas Insurance Commissioner Sandy Praeger said many are ones that might make a real difference for consumers.

When they apply in an individual case depends on the health insurance a person has: The effective date is the start of your new insurance year, assuming it starts on or after Sept. 23.

For most people covered by insurance through their employer, that means Jan. 1. But some employers have other renewal dates.

In addition, some health plans will have grandfathered status and won't have to comply with all these changes until later.

Here is a look at how the changes might affect you:

Lifetime limits

Until now, most health insurance policies have had a limit — maybe $1 million or $5 million — on how much they would pay out over a lifetime. Limits on "essential benefits" end, though that term still is being defined.

Few people come close to the limits, according to Karen Vines, director of business development and client services at IMA of Kansas. She calls the provision "a feel-good benefit."

But for Sharon Wilkinson, it's reassurance.

Anna Wilkinson, who turned 6 about a week ago, was born with a rare condition called vein of Galen malformation, a form of brain aneurysm.

Anna was hospitalized for six weeks so neurosurgeons could slow the blood flow. She had surgery for more repair work when she was 1.

When she was 3, doctors discovered an unrelated brain tumor. She had surgery, six weeks of sedated radiation and a year of high-dose chemotherapy. She's doing fine but requires a follow-up MRI every four months, along with physical, occupational and speech therapy.

Wilkinson doesn't know how much has been spent on Anna's treatment, but "as a parent, to even have to worry about that for a 3-year-old.... We were already well on our way to possibly reaching that lifetime maximum."

So although she didn't follow the health care debate, "I was really pleased" about the end to lifetime limits.

Annual limits start being phased out as well.

Dependent coverage

Family health insurance usually includes college students to age 24 or so. That will change to age 26 — and the adult child doesn't have to be a student.

The change applies only to medical coverage, not to dental or vision benefits, Vines said. And it doesn't change how dependents are viewed by the Internal Revenue Service.

Adult children can be carried on their parents' policies even if they don't live at home, even if they're eligible for other coverage and even if they're married. But the children's spouses and children can't be.

Cindy Miles' children are 23 and 25, and both work in the food industry, where health insurance benefits are rare.

Miles' benefits year begins July 1, so her children aren't eligible until then. Her son, who spends $90 a month on medication, will be 26 by then and out of luck because coverage ends when the person turns 26.

For Rick Case, the news is good. His children are students at the University of Kansas, and his son should graduate in the spring but is talking about grad school.

"It's one less cost to the kids while they try to launch their own careers or continue their education," he said. "You sure don't want your kids going without coverage."

Flexible spending accounts

For everyone with health flexible spending plans, the rules change Jan. 1. Over-the-counter medication no longer is included, unless a prescription for it has been written by your physician.

"I'm not sure who's happy with that provision," said Vines, whose husband will have to get a prescription to continue using flex spending for his allergy medication, even though it's available without a prescription.

The change could have even more implications in years to come, as more medicine goes to over-the-counter status.

Beckie Avery is unhappy that her family no longer will be able to use flex spending for over-the-counter medicine, such as the daily dose of aspirin she takes.

She's looking ahead, too: Beginning in 2013, the maximum someone can put in a plan will be $2,500. Now, there's no required limit, though employers may set one.

"We have three children, and they're all very close in age, and they will probably all be in braces at the same time," she said. "And when I look at the sticker prices for braces..."

Pre-existing conditions

Exclusions based on pre-existing conditions will be prohibited for those under age 19. Beginning in 2014, exclusions will be prohibited for adults as well.

For most people covered by insurance through their job, this won't have much impact, Vines said. It's more of a change for those who have individual policies.

It could have affected daughter Anna's coverage when Wilkinson changed jobs a few years ago because of the required waiting period. Thankfully, Wilkinson said, Anna's health was fine during that period.

Adults with pre-existing medical conditions who are uninsured may be eligible for a new temporary federal high-risk pool, Praeger said.

More information is available by calling 877-505-0511 or at www.khiastatepool.com.

Other provisions

Here's a quick look at a few other provisions that may affect consumers:

* Preventive services: Certain preventive services, such as blood pressure testing, children's immunizations or some cancer screenings, won't have a co-pay or other cost sharing. But if a preventive service is billed separately from an office visit, you still might have a co-pay. And you may have a cost if you go out of network.

* Recissions: Coverage can't be canceled retroactively except for fraud or intentional misrepresentation. "Mistakes can no longer be used as a viable reason for rescinding a policy," Praeger said.

* Emergency services: You don't have to go to an in-network emergency room, and you don't have to pay more for out-of-network emergency room services.

The U.S. government's website has some additional details for consumers. It's at www.healthcare.gov.

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