F2F HIC - Federal Health Changes

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Champions for Children with Disabilities

Coverage for Adult Children Under 26 on Their Parents’ Plan

The health care reform law states that insurance providers offering dependent coverage must allow adult children to be covered on their parent’s health plans until they reach age 26, regardless of if they are married or if they are not living at home. The only exception is for adult children who can receive insurance from their own employer; this exception ends in 2014. This law took effect on September 23, 2010. Your insurance provider must have an enrollment period for your adult child under 26 to be placed on your family plan. Call your insurance company and ask when the open enrollment times are and how to enroll your child.

For more detailed information on coverage for adult children under 26, please see Explaining Health Care Reform: Questions About the Extension of Dependent Coverage to Age 26 from the Kaiser Family Foundation or Young Adults and the Affordable Care Act produced by the U.S. Department of Health and Human Services. Contact your own insurance provider about your individual policy.

Health Reform for Americans with Disabilities:

HealthCare.gov

HealthCare.gov is a recent website launched by the federal government to help health care consumers. The website provides:

One-stop access to all your insurance options. HealthCare.gov helps in your search for insurance by giving you all your insurance options based on information you provide, including your age, location, and other important life circumstances.
Information on the new health reform laws and your rights as a patient. The website gives you information about the different provisions of the Affordable Care Act and has a timeline of implementation through 2015.
Helpful tips for preventative care. HealthCare.gov gives useful tips on how to stay healthy based on your situation.
Comparisons of hospital care. The website allows you to enter your zip code and compare the quality of care provided by hospitals in your area.

HHS has announced a new website, CuidadodeSalud.gov, the first website of its kind in Spanish, to help consumers take control of their health care by connecting them to new information and resources to help them access quality, affordable health care coverage. CuidadodeSalud.gov is a partner site of HealthCare.gov, and has information specifically for people with disabilities in the Personas con Incapacidad section of the site.
For more information visit this link: http://www.disability.gov/health/health_care/finding_health_care

Health Reform Hits Main Street – a video produced by the Kaiser Family Foundation
Confused about how the new health reform law really works? This 9 minute, animated movie explains the problems with the current health care system, the changes that are happening now, and the big changes coming in 2014.

The Patient Protection and Affordable Care Act gives Americans with disabilities greater control over their own health care.

Greater Choices for Americans with Disabilities

Expands the Medicaid Program

Expands the Medicaid program to more Americans, including people with disabilities.

Extends Essential Benefits

For most insurance policies, the following will be considered essential: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services (including behavioral health treatment), prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care.

New Options for Long-Term Supports and Services

Provides a new, voluntary and self-insured insurance program (CLASS Act) that helps families pay for the costs of long-term supports and services if a loved one develops a disability.
Creates new options for states to provide home and community based services in Medicaid, enabling more people with disabilities to access long-term services in the setting they choose.
Extends the Money Follows the Person program until 2016 and makes improvements to the Medicaid Home- and Community-Based Services (HCBS) option.

Eliminates Insurance Company Discrimination

Beginning in September 2010, prohibits insurance companies from denying children coverage based on pre-existing conditions. By 2014, the Act will prohibit insurance companies from denying coverage or charging more to any person based on their medical history, including genetic information.
In 2010, the Act provides access to affordable insurance for uninsured Americans with pre-existing conditions through a temporary, subsidized high-risk pool, which will help protect them from medical bankruptcy. This high risk pool is a stop-gap measure that will serve as a bridge to a reformed health insurance marketplace.

More Affordable Choices and Competition

Requires the creation of state-based health insurance Exchanges by 2014 in all states to provide families with the same private insurance choices that the President and Members of Congress will have, including multi-state plans to foster competition and increase consumer choice.

One-Stop Shopping

Provides standardized, easy-to-understand information through the Exchange on different health insurance plans so Americans can easily compare health plans to choose a quality, affordable option that is right for them.

Insurance Security

Ensures that families always have guaranteed choices of quality, affordable health insurance whether they lose their job, switch jobs, move, or get sick, through the creation of Exchanges.

Makes Health Care Accessible to Everyone

Provides access to health insurance through Exchanges to those without job-based coverage and provides premium tax credits to those who cannot afford coverage, significantly increasing access to a choice of health insurance plans for individuals with disabilities. This will enable individuals to keep their jobs rather than giving up employment in order to receive Medicaid benefits.

Lowering Costs by Rewarding Quality and Cutting Waste

Insurance Industry Reforms that Save Money

This year, eliminates all lifetime limits on how much insurance companies cover if beneficiaries get sick and bans insurance companies from dropping people from coverage when they get sick. The Act also restricts the use of annual limits in all new plans and existing employer plans this year, until 2014 when all annual limits are prohibited.
Going forward, plans in the new Health Insurance Exchanges and all new plans will have a cap on what insurance companies can require beneficiaries to pay in out-of-pocket expenses, such as co-pays and deductibles.

Supports states starting in plan year 2011 in requiring health insurance companies to submit justification for requested premium increases, and insurance companies with excessive or unjustified premium exchanges may not be able to participate in Exchanges.
Cracks down on excessive insurance overhead starting in 2011 by applying standards to how much insurance companies can spend on non-medical costs, such as bureaucracy, executive salaries, and marketing, and provides consumers a rebate if non-medical costs are too high.

Assuring Accessible, Quality & Affordable Health Care for People with Disabilities

Preventive Care for Better Health

In 2010, requires new plans to cover most prevention and wellness benefits at no charge to American families by exempting these benefits from deductibles and other cost-sharing requirements.
Invests in prevention and public health to encourage innovations in health care that prevent illness and disease before they require more costly treatment. People with disabilities will be more likely to receive preventive care and less likely to be diagnosed with screen-able cancers during later stages.
Improves access to medical diagnostic equipment so people with disabilities can receive routine preventive care.

Addresses Health Disparities

Moves toward eliminating disparities by improving data collection on health disparities for individuals with disabilities and improving training of health providers.

Improves Care for Chronic Disease

Invests in innovations such as medical homes and care coordination demonstrations in Medicare and Medicaid to prevent disabilities from occurring and progressing and to assist the one in every ten Americans who experience a major limitation in activity because of a chronic condition.

-Adapted from “Health Reform for Americans with Disabilities” produced by WhiteHouse.gov

For more detailed information on the health reforms, please see the following links:

HealthCare.gov managed by the U.S. Department of Health & Human Services
Pre-Existing Condition Insurance Plan Coverage is a website produced by HealthCare.gov that provides information on insurance plans for people with pre-existing conditions and has the application for health care coverage.
Committee on Energy & Commerce: Health Care Reform is a timeline of federal health care reforms through 2018.
Families USA: Health Reform Central gives detailed information about the new health care laws, including what they mean, how they will be implemented, and what may be roadblocks in implementing the law.
Impact of Health Care Reform on People with Disabilities
Summary of New Health Reform Law, produced by the Kaiser Family Foundation, is a detailed summary of the exact provisions of the Patient Protection and Affordable Care Act.
Summary on Affordable Health Care for America is a short summary of the Patient Protection and Affordable Care Act that was written by a House Committee.

To learn more about the new federal health reforms, contact PACER’s Family-to-Family Health Information Center at (952) 838-9000 or (800) 53-PACER, toll free in Minnesota.

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