By now, every American has probably heard that President Obama signed into law March 23 the Patient Protection and Affordable Care Act (HR 3590). As this bill is approximately 2,700 pages long, however, it’s doubtful anyone has yet read it cover to cover. Your patients, of course, will expect you to know how this health care reform affects them. To spare you the daunting task of reading the expansive legislation, the American Medical Association (AMA) has summarized how the bill will impact your patients this year.

According to the AMA, the following applies to patients with private insurance:

• Your insurer can no longer drop you from your plan if you get sick.
• Children ages 18 and younger can no longer be denied private insurance coverage if they have a pre-existing medical condition.
• For adults with pre-existing medical conditions who cannot obtain private insurance coverage, a temporary national “high-risk pool” will be established to provide coverage, with financial subsidies to make premiums more affordable, until all insurers are required to cover people with pre-existing conditions in 2014.
• Young adults up to age 26 can remain as a dependent on parents’ private health insurance plan.
• Your health insurance benefits can no longer run out because of a long or expensive illness because insurers can no longer impose lifetime financial limits on benefits.
• Preventive services for women, such as mammograms, and immunizations for children must be covered by insurers, with no co-payments or deductibles required.

For Medicare and Medicaid patients:

• Patients who will hit the coverage gap known as the “doughnut hole” this year under the prescription drug benefit will receive a $250 rebate from Medicare.
• Patients will no longer pay any cost-sharing for a number of preventive services, effective Jan. 1, 2011.
• Patients subject to the “doughnut hole” for Medicare drug coverage will receive a 50 percent discount on those prescription drugs beginning Jan. 1, 2011.

3 Responses to “How HRC Presently Affects Your Patients”

1. Frances Staudter Says:
   April 8th, 2010 at 3:46 am

   Three major faults with our health care system have not been addressed, Torte laws, capping the amount allowed in the annual rise of insurance premiums and the cost of medication . Doesn’t anyone else realize this. If providers don’t stand together, you will all fall , one by one, alone.

2. mary mahoney Says:
   April 8th, 2010 at 1:24 pm

   Do young adults need to be full time students to stay on parents insurance until they are 26?

3. Shanon Says:
   April 10th, 2010 at 5:58 am

   Mary, it appears that they do not need to be full time students. However, if they don’t meet the IRS definition of dependent the premium will be subject to imputed income provisions. Also, I’ve heard conflicting information on whether this change applies to self-funded employer-sponsored plans.
   See Section 2714 of the Senate Bill:
   (a) In General – “A group health plan… that provides dependent coverage of children shall continue to make such coverage available for an adult child (who is not married) until the child turns 26 years of age”
   (b) Regulations – The secretary shall promulgate regulations to define the dependents to which coverage shall be made available
   (c) Rule of Construction – Nothing in this section shall be construed to modify the definition of ‘dependent’ as used in the Internal Revenue Code of 1986 with respect to the tax treatment of the cost coverage.

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