The nation's six-month-old health care law just started delivering protections and dollars-and-cents benefits. But it won't affect all consumers the same way, which may cause confusion. Here are straightforward answers to some very important questions.
Has Everyone's Health Insurance Changed?
No. It depends on when your health insurance plan year starts. Many of the new restrictions begin with plan years starting on or after Sept. 23. But if your plan starts January 1, as many do, that's when the changes start.
"Grandfathered" plans - those that existed before the law was enacted March 23 and which remain essentially unchanged - must meet only some of the requirements. New plans and those with significant changes in benefits or out-of-pocket costs must comply with even more changes in the law.
How Do I Know How My Health Plan Fits in All This?
If you get insurance through work, ask your employer about any changes. If you buy insurance yourself, call your insurance company.
What Are Some of the New Benefits?
Free preventive care, for one. Some people will no longer have to pay co-pays, co-insurance or meet their deductibles for preventive care that's backed up by the best scientific evidence. That includes flu vaccines, mammograms and even diet counseling for adults at risk of chronic disease.
Are There Exceptions?
Free preventive care isn't required of existing health plans that haven't changed significantly, those "grandfathered" plans mentioned earlier. New plans, and those that change substantially on or after Sept. 23, must provide this benefit.
What Other Changes Are Now in Effect?
If you go to an emergency room outside your plan's network, you won't get charged extra. Patients will be able to designate a pediatrician or an ob-gyn as their primary-care doctor, avoiding the need for referrals that are required by some plans.
Are Lifetime Limits Being Eliminated?
Millions of Americans have insurance that sets a cap on what their insurance will pay to cover their medical costs over a lifetime. The caps have left very sick patients with medical bills topping $1 million or $2 million high and dry. These lifetime limits are eliminated for plans issued or renewed on or after Sept. 23.
Those who have maxed out because of the caps but remain eligible for coverage must be reinstated on the first day of the plan year
that begins on or after Sept. 23.
What About Annual Limits?
Plans issued or renewed on or after Sept. 23 can't have annual limits lower than $750,000. Annual limits will be eliminated entirely by 2014.
Any Exceptions to the New Annual Limit Rule?
Employers and insurance companies can apply for waivers for so-called "mini-med" plans that offer limited benefits. The intent of the waivers is to allow these low-cost plans to exist so that people don't lose their health coverage when premiums go up.
Any Changes that Affect Parents?
Insurers can no longer deny coverage to children with pre-existing conditions. Also, parents can keep their adult children on their health plans until age 26.
Is It True that Some Insurers Willl No Longer Sell Child-Only Policies?
Companies in some states have said the new requirement to insure children with pre-existing conditions will lead to unpredictable costs. Their decision to stop selling such policies won't affect existing plans.
Most children are covered under family insurance plans. The trade group America's Health Insurance Plans estimates that about 8 percent of all plans sold on the individual market that cover one person are for people under age 18.