Key Provisions of the Law Became Effective on September 23, 2010
September 23, 2010, marked six months since the Congress enacted and President Obama signed into law the Patient Protection and Affordable Care Act. The law will not be fully implemented until 2014, but important provisions of the Affordable Care Act are effective beginning September 23, 2010, including some that offer important protections to those with brain tumors.
- Extending coverage for young adults - The new law permits young adults up to age 26 to remain on their parents’ health plan, unless they have insurance coverage at work. This extension of coverage may provide young adults with brain tumors critical access to health insurance. This protection begins on September 23, 2010, but a number of insurers offered this protection in advance of the effective date.
- Protecting children from pre-existing condition exclusions - Beginning on September 23, 2010, some insurance companies are prohibited from turning down a child for insurance coverage or excluding a child’s condition from a family’s insurance coverage.
- Protecting Americans from losing their insurance - Insurance companies will be prevented from rescinding coverage once an individual is covered under a plan. The only exceptions are in those cases where the individual committed fraud.
- Preventing the imposition of lifetime benefit limits - Beginning on September 23, 2010, the Affordable Care Act prevents insurers from imposing lifetime benefit limits. This protection may be especially beneficial to brain tumor patients who undergo expensive treatment that in the past would have triggered a lifetime benefit limit. Although a relatively limited number of individuals hit lifetime limits, the loss of benefits can be devastating for those who hit the limit.
- Enhancing protections against annual benefit limits - Annual benefit limits will be eliminated for most insurance plans by 2014, with annual spending limits increasing each year until that time. Annual limits have posed a real threat of loss of insurance coverage for brain tumor patients in any year when they undergo intensive treatment, and the incremental elimination of these limits represents an important protection for these patients.
- Enhancing access to preventive care - All new insurance plans are required to cover preventive care benefits without charging a deductible, co-payment, or co-insurance amount. The benefits that will be available without cost-sharing include many services that are important to brain tumor survivors as part of their follow-up and survivorship care.
- Protecting rights to appeal denials of care - Protections in the Affordable Care Act will govern how plans must handle the initial appeals filed by consumers when their care is denied. In addition, the law permits patients to appeal to an independent reviewer who does not work for their health plan.
- Pre-existing condition insurance plan - On July 1, 2010, a new insurance program went into effect for those who have been uninsured for at least six months because of a pre-existing condition. States may choose to run this insurance program themselves, or the Department of Health and Human Services will run the program in those states that choose not to run their own program.
Between 2010 and 2014, additional health care benefits will become effective, innovations in health care delivery and payment will be implemented, and steps toward the health insurance exchanges will be taken. Additional insurance reforms will become effective in 2014, including a requirement that insurers pay the routine patient care costs for those enrolled in clinical trials.
Certain plans - those that were in effect on March 23, 2010, and that remain significantly unchanged - are considered "grandfathered plans" and will not be subject to all of the insurance reforms outlined above. If you like your insurance plan and choose to keep it, you may be in a grandfathered plan.
NBTS will continue to monitor the implementation of the Affordable Care Act, its benefits for brain tumor patients, and any problems associated with its implementation.
If you have questions about the implementation of the Affordable Care Act or about finding health insurance coverage, following are several links to websites that may provide helpful information.
The United States Department of Health and Human Services has information on implementation of the Affordable Care Act and accessing insurance coverage.
The Kaiser Family Foundation has information on the implementation on the Affordable Care Act and health reform in general.
Families USA has state-by-state information on accessing health care coverage.