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How Health Reform Will Affect You

If you are currently covered by an employer-based plan:

  • Nothing will change. Your benefits will stay in place unless your employer chooses to change them. If you are covered by a collective bargaining agreement, your benefits will stay the same until the contract expires and is re-negotiated as usual. Generally, the following provisions go into effect this September or at the expiration of your collective bargaining agreement.
  • If you have a family plan, you will be able to include your children up to age 26 on your plan. And no child under the age of 19 can be denied coverage because of pre-existing conditions.
  • Beginning in September, insurers will be banned from placing lifetime caps on the amount of money they'll pay for your treatment. Beginning in 2014, they can't cap yearly costs either.
  • Your insurance company will be prohibited from dropping coverage because you get sick.
  • Beginning next year, if your employer chooses to participate by establishing a payroll deduction, you can buy into a long-term care plan that will provide cash benefits of $50-$100 per day toward the cost of services that will allow you to remain in your home if you become sick—such as home health care, medical equipment or even wheelchair ramps.
  • All new health plans must provide certain preventive services, vaccinations and screenings for free. It's not clear at this point when this requirement will apply to existing employer plans.

If you are retired and on Medicare:

  • Your benefits will not change.
  • If you are in the Medicare, Part D "donut hole," you will automatically receive $250 this year toward your drug costs. Starting in 2011 you'll get a 50% discount on pharmaceuticals you buy in the gap. Over the next ten years you will receive more discounts and the donut hole will be eliminated by 2020.
  • Beginning in 2011 you can get an annual physical and many preventive services free from traditional Medicare as a new Part B benefit.
  • Cost savings from the new law should keep Medicare fiscally strong for at least ten years longer than if the bill had not passed.
  • If you are in a Medicare Advantage plan, your insurance company is currently getting paid more than Medicare pays for the same treatments and procedures. MA plans also charge higher co-payments than Medicare for certain services. This built-in excessive profit will gradually be phased out. As a result, some MA plans may choose in the future to raise premiums or cut services in order to protect their profits.

If you or a loved one are uninsured:

  • Beginning in 2014 you will be able to buy low-cost insurance through state "exchanges" that allow you to see which one is best for your needs. If your income is at 400 percent of the federal poverty level or below, you'll be eligible for subsidies that will greatly reduce your costs.
  • Beginning in 2010, if you have a pre-existing condition and have been uninsured for at least six months you can buy insurance through a temporary program that will provide coverage and limit the amount you can be required to pay out-of-pocket.
  • If you have a child under the age of 26 who is uninsured, he or she can be covered under your plan.
  • Beginning in 2014, you can't be denied coverage because of a pre-existing condition.