Opinion Columns & Blogs

How health care reform law might affect you

No matter what you thought of the noisy debate in Congress about health insurance reform, it's important to learn how the new law might affect you personally.

People in Medicare, people who seek coverage in the individual marketplace, and people who get health insurance through their employers all will be affected. By knowing what's in the new law and when the different benefits take effect, you can take advantage of the new provisions for yourself and your family.

Starting this year, consumers who have been unable to buy insurance because of pre-existing conditions and are not already part of the state's high-risk insurance pool may be eligible for a temporary program of affordable coverage. In 2014, insurance companies will no longer deny you coverage because of a pre-existing condition. Instead, individuals — just like members of Congress — will have access to a choice of insurance options through a marketplace of new, more affordable plans.

Consumers also should be aware that insurers will be prohibited from imposing lifetime benefit caps or unreasonable annual limits, starting this year. Similarly, they will be prohibited from cutting off coverage when you get sick.

And consumers who have adult children who need coverage may keep them on their employer plan until they reach age 26.

The new law will help seniors who are paying thousands of dollars out of their own pockets for their medications because they've fallen into the Medicare Part D coverage gap or "doughnut hole." This year Kansans in the coverage gap will get a $250 rebate. Next year they will get a 50 percent discount on brand-name drugs. Within 10 years, the coverage gap will be eliminated.

Out-of-pocket costs for prevention are going to go down. Starting next year, patients in Medicare can get annual wellness checkups free of charge, along with important preventive services such as screenings for cancer and diabetes.

Consumers of private health insurance also will qualify for free health screenings, a change from the past practice of charging co-payments.

Independent living is another priority of the new law. States will get financial help to expand home- and community-based services. And people may participate in a new voluntary insurance program that helps cover the kinds of support they may need one day to stay out of nursing homes.

Some of the new law's little-known features may encourage employers to continue providing health care to early retirees. Early retirees who receive medical benefits are more likely to retain them, because the federal government will help employers provide them. Workers in small firms are more likely to get — and keep — employer health benefits, because of a new tax credit for small companies that offer health care.

The new law also takes steps to keep doctors' doors open for Medicare patients. Physicians will get bonus payments for primary care, a little-noticed strategy to promote access for seniors.

And it is important to note what is not changing under health insurance reform. The law explicitly prohibits any cuts to seniors' guaranteed Medicare benefits.

Individuals should do what they can to learn what the new provisions mean for them. Many websites offer useful information about the law, including www.aarp.org/getthefacts.