Six changes in health care that may affect you


Jasmine Wright, left, gets her blood pressure checked by registered nurse specialist Bruce Major, right, at the Santa Fe College Student Health Care Center on Sept. 27, 2010.

Aaron Daye/staff photographer/file
Published: Wednesday, January 5, 2011 at 6:55 p.m.
Last Modified: Wednesday, January 5, 2011 at 6:55 p.m.

Congressional opponents of the new health care overhaul are threatening to repeal the Affordable Care Act that was signed into law by President Obama on March 23, 2010.

Facts

Changes at a glance:

* Parents can keep adult children on their health insurance until the age of 26.

* All health insurance plans must cover kids under the age of 19, even if they have pre-existing medical conditions.
* Employer plans must spend 80% to 85% of premium dollars on services related to medical care, not administrative costs.
* Those with flexible spending accounts for medical needs no longer can spend the money on over-the-counter drugs.
* Seniors who reach the coverage gap will get a 50 percent discount when buying brand-name prescription drugs under Medicare Part D.
* Seniors will get free preventive benefits, such as annual wellness visits, under Medicare Part B.

But at least six provisions of the new law went into effect on Jan. 1 and likely will affect most residents of North Central Florida this year.

Health insurance agencies will have to make the most changes to their systems, and the adjustments will affect who has coverage — and what is covered.

Other key components offer good news to seniors as part of an effort to focus on preventative medicine, rather than trying to cure health problems after they arise.

Here's a breakdown of what you can expect:

For parents

1. You can keep your adult child on your health insurance coverage until the age of 26.

Previously, many insurers placed limits on coverage for older children. Some wouldn't cover children older than age 19 unless they were full-time students; others required older children to live at home to be eligible for coverage.

Now, all children up to age 26 are eligible, as long as they don't have access to an employer-provided plan.

"The child doesn't have to be your dependent, doesn't have to be living with you, can be married or unmarried, and doesn't have to be attending school," according to a spokeswoman for the National Business Group on Health.

2. Your insurer must cover children under the age of 19, even if they have a pre-existing medical condition such as asthma or cancer.

Insurers may limit when children are signed up to certain open enrollment periods. Similar protections for adults with pre-existing medical conditions won't be in place until 2014.

For seniors

3. Participants in the Medicare Part D prescription drug program will see the "doughnut hole" shrink. If you spend between $2,840 and $4,550 on prescription drugs this year, you will receive a 50 percent discount on name-brand drugs. Before this change, you were required to foot the entire bill. Still have questions? Call 1-800-MEDICARE (1-800-633-4227). The "doughnut hole" will be phased out completely by 2020.

4. Medicare beneficiaries get an expanded list of free preventative benefits, including the "Welcome to Medicare" physical exam for new enrollees under Medicare Part B. You also can get an annual wellness visit and personalized prevention plan. Medicare no longer will charge co-pays or deductibles for services such as mammograms, screenings for cervical and colorectal caner, cholesterol tests, flu shots, pneumonia shots, hepatitis B shots and certain kinds of prostate-cancer screenings.

Check them out under the "Manage Your Health" section of Medicare.gov.

For insurers

5. Insurance companies will be required to spend 80-85 percent of the premium dollars you pay on medical and health care quality improvement, rather than on administrative costs. If they don't meet these percentages because their costs or profits are too high, they'll be required to provide a rebate to customers starting in 2012.

Many insurance plans now must provide some preventive-care screenings without charging a deductible or co-payment. The preventive-care page at Healthcare.gov provides a comprehensive list of free services and eligibility requirements.

If your health insurance plan has not made major changes in its costs and benefits since health care reform was enacted, these benefits might not apply. Check with your insurer or your employer's benefits office to see if your plan qualifies.

Alachua County residents might wonder if their benefits under CHOICES will change. Director Bob Bailey said Tuesday, "The quick answer is ‘no'," adding that these changes relate to health insurance companies, "which we are not."

For employees

6. If you choose to pay for health care costs out of a flexible spending account, which uses pre-tax income, you no longer may spend the money on over-the-counter drugs, including ones that treat fevers, allergies or acne, unless you have a doctor's prescription. Insulin and medical devices such as eyeglasses and crutches still qualify for the accounts. Use the money inappropriately and you will not only owe taxes on it but also face a tax penalty of 20 percent.

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