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The Affordable Care Act (Obamacare): If You Have Health Insurance


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Through your employer:

  • You can keep your health insurance.
  • You cannot be discriminated against for participating in a clinical trial. Incidental medical costs will be covered.
  • Because of the Affordable Care Act::
    • Lifetime limits on coverage have been eliminated.
    • Insurers cannot cancel policies just because a policyholder gets sick.
    • Children are allowed to stay on a parent's policy until age 26.
    • If your plan includes coverage for children, coverage cannot be denied because of a child's pre-existing condition.
  • Starting in 2013, 
    • Flexible Spending Accounts will be limited to $2,500. Funds will no longer be able to be used for over-the-counter medications unless they are prescribed by a doctor.
    • Families making more than $250,000 (including unearned income) will pay more Medicare Part A payroll taxes.
  • Starting in 2014:
    • You will also have the choice to purchase coverage through a state-based Exchange.
    • All new plans must contain a minimum package of benefits, including preventive services such as immunizations. Patient costs relating to clinical trials must be covered.
    • Insurers will not be able to deny coverage or charge more because of a pre-existing health condition.
  • Starting in 2018, insurers will pay an excise tax on plans with high premiums. This may result in higher premiums or lower benefits.

On your own:

  • You can keep your health insurance.
  • You cannot be discriminated against for participating in a clinical trial. Incidental medical costs will be covered.
  • Starting September, 2010:
    • You have the choice to cover children up to age 26 on your policy
    • Insurers have to eliminate annual limits in coverage.
    • Insurers will not be able to cancel a policy just because a policyholder becomes sick.
  • Starting in 2013, families making more than $250,000 (including unearned income) will pay more in Medicare Part A payroll taxes.
  • Starting in 2014:
    • You will have the opportunity to purchase coverage through an Exchange
    • Your health plan must cover the incidental costs of participating in a clinical trial.
  • Young people are likely to face increases in premiums because the law limits charges to older adults to a maximum of three times what the company charges to young adults.

Through Medicare

  • Preventive care will be added to Medicare.
  • People with Medicare Part D (drug coverage):
    • Will get a $250 rebate in 2010 when they reach the dough nut hole.
    • Starting in 2011, pharmaceutical manufacturers must provide a discount  on brand -name drugs filled in the Medicare Part D "doughnut hole."  
    • Will see their co-pay go from 100% to 25% by 2020
  • Premium subsidies would be reduced for individuals making more than $85,000 or couples making more than $170,000.
  • Medicare Advantage:starting in 2011, premium subsidies will be reduced.  Some analysts believe that the likely effect will be higher premiums or decreased coverage.

Through Medicaid:

  • Until 2019, States are prohibited from cutting children from Medicaid or CHIP (Children's Health Insurance Program).
  • States must retain current eligibility requirements for adults until 2014. 
  • States are prohibited from terminating your Medicaid coverage until 2014 when the Exchanges start, unless the state forecasts a budget shortfall.

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