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Six Months of the Affordable Care Act

http://www.HealthCare.gov

In the six months since President Obama signed the Affordable Care Act into law, we have been hard at work implementing the law and focusing on putting consumers ahead of insurance companies.

Already, millions of Americans are seeing the benefits:

  • Nearly 4 million employees working for small businesses can benefit from small business tax credits to help employers cover their employees.
  • Thousands of uninsured Americans who had been locked out of the market due to pre-existing conditions have signed up for the Pre-Existing Condition Insurance Plan.
  • More than 2,000 businesses have been accepted into the Early Retiree Reinsurance Program, which provides them much needed financial support to continue coverage for retired Americans not yet eligible for Medicare.
  • More than one million Medicare beneficiaries have received a $250 check to help them afford the cost of prescription drugs in the Part D “donut hole” coverage gap.  In addition, beneficiaries in the donut hole will see more money in their pockets, thanks to a 50-percent discount on brand name drugs in 2011.

We’ve also kept a close eye on insurance companies, calling out unjustified premium increases and encouraging them to put in place common sense policies.

And today, a number of other benefits are beginning to take effect.

Insurers will no longer be able to:

  • Deny coverage to kids with pre-existing conditions. Health plans cannot limit or deny benefits or deny coverage for a child younger than age 19 simply because the child has a pre-existing condition like asthma.
  • Put lifetime limits on benefits. Health plans can no longer put a lifetime dollar limit on the benefits of people with costly conditions like cancer
  • Cancel your policy without proving fraud. Health plans can’t retroactively cancel insurance coverage – often at the time you need it most - solely because you or your employer made an honest mistake on your insurance application.
  • Deny claims without a chance for appeal. In new health plans, you now have the right to demand that your health plan reconsider a decision to deny payment for a test or treatment. That also includes an external appeal to an independent reviewer.

Consumers in new health plans will be able to:

  • Receive cost-free preventive services. New health plans must give you access to recommended preventive services such as screenings, vaccinations and counseling without any out-of-pocket costs to you.
  • Keep young adults on a parent’s plan until age 26. If your health plan covers children, you can now most likely add or keep your children on your health insurance policy until they turn 26 years old if they don’t have coverage on the job.
  • Choose a primary care doctor, ob/gyn and pediatrician. New health plans must let you choose the primary care doctor or pediatrician you want from your health plan’s provider network and let you see an OB-GYN doctor without needing a referral from another doctor.
  • Use the nearest emergency room without penalty. New health plans can’t require you to get prior approval before seeking emergency room services from a provider or hospital outside your plan’s network – and they can’t require higher copayments or co-insurance for out-of-network emergency room services.

Check out our latest video about these changes here: http://bit.ly/aFJPiH

Make sure you visit HealthCare.gov for more information on new provisions going into effect today, September 23rd.

Sincerely,

Kathleen Sebelius
Secretary, Health and Human Services

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