I've been hearing a lot about the six-month anniversary of
health-care reform, and I know that a few parts of the new law
are supposed to take effect then. What is changing?
September 23 marks the six-month anniversary of the landmark
health-care-reform law, when several key provisions kick in.
Despite the hoopla, most consumers won't notice changes in their
health-insurance coverage until the beginning of the next plan year
(generally January 1 for most people who get their insurance at
work). Here's what to expect if you have employer-based coverage.
The rules and deadlines are slightly different if you buy your
insurance on your own. I'll cover changes that affect individual
policies in my next column.
New coverage for kids big and small.
One of the biggest changes in the new health-care-reform law is
that parents can keep their adult children on their policies up to
age 26 (or add them back on to the policy if they had dropped off
because they were too old). The rule takes effect in the plan year
that starts on or after September 23 (which is January 1 for most
employer policies). See
Keeping Adult Children Insured
for more information about this rule.
Even though coverage won't begin until January 1, 2011, most
families who want to take advantage of this new provision have to
act soon: You'll need to add your child to your policy during
open-enrollment season this fall. See
Health Insurance Changes for 2011
for more information about open-enrollment decisions.
If you already have family coverage for younger children, adding
an adult child to your policy probably won't cost you extra. But if
your employer charges separately for each dependent, it might be
cheaper for your adult child to get his own policy. Healthy adults
in their twenties can usually buy a policy in most states for less
than $100 a month. You can shop for a policy through
, get a list of policies available in your area at
, or find a local agent at
Younger children also get new protections under the new law.
Insurers are prohibited from denying coverage to children under age
19 because of a preexisting medical condition, which applies to
most plans on January 1.
Free preventive-care benefits.
Many people will no longer have to pay co-payments, coinsurance or
meet deductibles for routine preventative care. Depending on your
age, this rule may apply to blood-pressure, diabetes and
cholesterol tests, mammograms and colonoscopies, flu shots, routine
vaccines, and well-baby and well-child visits. While free
preventative-care benefits will be available in many employer-based
plans beginning January 1, there are exceptions.
For example, these benefits may not apply if you have a
"grandfathered" plan. Some existing health plans that have not made
major changes to their costs and benefits since health-care-reform
was enacted are not subject to some of the consumer protections
that new plans or non-grandfathered plans must follow. Ask your
insurer whether your plan is considered to be "grandfathered" --
the key word to use to find out whether some of these new
provisions will apply to you."
Lifetime-coverage limits disappear.
Health plans will no longer be allowed to impose a lifetime dollar
limit on most benefits. In the past, seriously ill patients with
health-insurance coverage could be on the hook for enormous medical
bills once they exhausted their benefits. Annual limits will be
phased out gradually between now and 2014. For plan years starting
between Sept. 23, 2010, and Sept. 23, 2011, employer plans can't
impose annual coverage limits of less than $750,000 (the limit
rises to $1.25 million for plan years starting after Sept. 23,
For more information about health-care reform, see our special
Health-Care Reform: What It Means to You