On Thursday, six months after President Barack Obama signed the health care overhaul into law, many of its provisions take effect -- including consumer protections and new benefits.
But don't expect your world to change.
Most changes apply to plans after they renew. For most people, that will be Oct. 1 or Jan. 1, but many won't see changes until later next year
The provisions taking effect now are intended to help people maintain or acquire health insurance until the law comes into full force in 2014. That year, insurance exchanges will be established. Small businesses and individuals will be able to shop for health-insurance plans, which will be required to meet certain standards.
Here's an overview of the major changes:
- Coverage for adult children up to age 26. Children can enroll in their parents' health plan until their 26th birthday, as long as they haven't been offered health insurance by an employer. Young adults are eligible even if they are married, not listed as dependents on parents' tax form, not attending school and not living with their parents. (This applies only if the parents' health plan offers dependent coverage, as most do.) For more details, see this fact sheet: http://www.hhs.gov/ociio/regulations/adult--child--fact--sheet.html
The federal law now extends the age of eligibility and removes the requirement to be a student.
- Coverage for preventive services. Consumers in new plans won't have to pay deductibles or co-pays for an array of preventive services, such as colon cancer screenings, mammograms, immunizations and well-child care.
In some Blue Cross plans, the cost of more invasive screening tests, such as colonoscopy, has been counted against a subscriber's deductible, said Monica Neronha, assistant vice president of legal services at Blue Cross. That will no longer be allowed in plans renewed after Thursday. Also gone will be co-pays for certain types of office visits or lab tests
Consumers may first notice the change when they go for an annual physical: They won't have to hand over the $10 or $20 normally required, Neronha said. "The annual physical itself isn't a preventive service, but all the things they're doing are preventive," she said.
- Consumer protections. Lifetime limits on coverage will be banned. But at least among Blue Cross plans, Neronha said, such limits were extremely rare. Insurers will also be barred from imposing annual limits on payments for "essential health benefits," such as hospitalization.
- Help for uninsured people with chronic illnesses. Some $13 million in federal money will be used to subsidize the premiums of some individuals who haven't been able to afford coverage because of their illnesses. With the subsidies, the sick will pay about the same rates as the healthy.
- Help for employers who cover early retirees. The Early Retiree Reinsurance Program applies to retirees 55 and older who are not eligible for Medicare but who are covered by employer-sponsored health insurance. The program pays 80 percent of the cost of any claims worth more than $15,000 and less than $90,000. For more information, go to www.errp.gov
- The small business tax credit. In calendar year 2010, businesses with 25 or fewer workers can receive a tax credit of up to 35 percent if they cover at least 50 percent of health-insurance premiums for their workers. But the amount of the credit varies based on the employees' average wage, and many companies with higher-paid employees won't qualify.
- Money for community health centers. Community health centers will be able to double the patients they serve with increased funding over four years. New centers may also be built.
- The Medicare Part D "donut hole." These tax-free rebates are for Medicare beneficiaries who bought enough prescription drugs that they reached a gap in coverage and had to start paying out of pocket. Checks will continue to be mailed out monthly as other people "hit the donut hole." The hole will gradually be closed by 2020.
Contact Providence Journal medical writer Felice J. Freyer at ffreyer(at)projo.com.