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7 Things You Don't Know About the Healthcare Reform

Key Points

  • The Patient Protection and Affordable Care Act, also known as "Obamacare", allows states to opt out of participation, with only 28 states planning to fully participate as of now.
  • Companies with 50 or more employees are not forced to comply with the new changes and some have chosen to pay fines for non-compliance rather than adhering to the regulations.
  • The healthcare reform act prohibits insurance companies from dropping policyholders when they get sick, a practice that was previously common.
  • The act also provides options for patients if their insurance claim is denied, including the opportunity to have an independent reviewer assess the claim.
  • The act bans lifetime limits on healthcare payouts and annual limits on insurance benefits, and makes much preventative care free, potentially reducing overall healthcare costs.

Healthcare reform, officially titled the Patient Protection and Affordable Care Act and also referred to politically as "Obamacare", passed in March 2010 and goes into effect in 2014. Perhaps no bill in history has been more confusing to the public than this one, but there are some important things consumers should know.

7 Things You Don't Know About the Healthcare Reform

Key Points

  • The Patient Protection and Affordable Care Act, also known as "Obamacare", allows states to opt out of participation, with only 28 states planning to fully participate as of now.
  • Companies with 50 or more employees are not forced to comply with the new changes and some have chosen to pay fines for non-compliance rather than adhering to the regulations.
  • The healthcare reform act prohibits insurance companies from dropping policyholders when they get sick, a practice that was previously common.
  • The act also provides options for patients if their insurance claim is denied, including the opportunity to have an independent reviewer assess the claim.
  • The act bans lifetime limits on healthcare payouts and annual limits on insurance benefits, and makes much preventative care free, potentially reducing overall healthcare costs.

Healthcare reform, officially titled the Patient Protection and Affordable Care Act and also referred to politically as "Obamacare", passed in March 2010 and goes into effect in 2014. Perhaps no bill in history has been more confusing to the public than this one, but there are some important things consumers should know.

1. Not All States Are Participating

Many of the citizens who worry about the broad changes to healthcare and Medicare won't even have to face the issue. The original bill required states to participate until at least 2017, but Obama made concessions to governors and revised the bill so that states can opt out as early as 2014, meaning many states won't really participate under the full force of the bill at all. Under current governors' administrations, only 28 states plan to fully participate in the health care reform. 

2. Some Companies Would Rather Pay Fines

Companies aren't forced to comply with the new changes. The healthcare act only applies to companies with 50 or more employees, and a considerable portion of those companies have chosen to simply pay fines and fees for non compliance instead of trying to abide by the regulations. Talk to your human relations department if you are in a participating state and aren't sure if your company intends to offer family care under the act.

3. Insurance Can't Drop You if You Get Sick

One of the reasons the healthcare act passed is because insurance companies were accepting premiums from customers for years, but when the person faced immediate healthcare issues, the company cancelled their policy and declined to pay their costs. The healthcare reform act makes this illegal.

4. If a Claim is Denied, Patients Have Options

Before the law passed, insurance companies could simply deny a patient's claim and there was nothing the patient could do except pay the bill out-of-pocket. The new law makes this harder to do to people. If the insurance company denies a claim, the insured can get an independent reviewer to look over the claim. In emergency or urgent care situations, the independent reviewer must make a decision within 72 hours.

5. Lifetime Limits on Health Care Payouts are Illegal

For years, companies have imposed a lifetime limit on how much they'll pay for an insured's healthcare expenses. The new law bans this practice. Most patients never face the lifetime limit, but those with chronic illnesses such as cystic fibrosis or Crohn's disease are often left without coverage, even after diligently paying their premiums.

6. Annual Limits on Insurance Benefits Also Banned

Insurance companies also habitually denied to pay healthcare costs over a certain amount each year. This didn't affect those who occasionally needed a walk-in clinic, but it did apply to people who had serious traffic accidents or a sudden cancer diagnosis. This practice is banned under the health care reform acts.

7. Much Preventative Care is Now Free

Many illnesses can be prevented or controlled with the proper checkups and preventative care, such as cancer screenings and immunizations. The affordable health care act makes many of these appointments, tests and treatments free, so health care will be cheaper because many illnesses are stopped before causing a problem.

Talk to your employer and doctor to find out exactly how the new law affects you.

Frequently asked questions

  • What is the Patient Protection and Affordable Care Act, also known as "Obamacare"?

    The Patient Protection and Affordable Care Act, also known as "Obamacare", is a healthcare reform bill that was passed in March 2010 and went into effect in 2014. It introduced a series of changes to healthcare and Medicare.
  • Are all states required to participate in the healthcare reform?

    No, not all states are required to participate. The original bill required states to participate until at least 2017, but revisions allowed states to opt out as early as 2014. As a result, not all states fully participate under the full force of the bill.
  • Are companies required to comply with the new healthcare changes?

    No, companies are not forced to comply with the new changes. The healthcare act only applies to companies with 50 or more employees, and some of these companies have chosen to pay fines and fees for non-compliance instead of trying to abide by the regulations.
  • Can insurance companies drop customers if they get sick?

    No, one of the key aspects of the healthcare reform act is that it makes it illegal for insurance companies to cancel a customer's policy and decline to pay their costs when they face immediate healthcare issues.
  • What happens if an insurance claim is denied under the new law?

    If an insurance claim is denied, the insured can get an independent reviewer to look over the claim. In emergency or urgent care situations, the independent reviewer must make a decision within 72 hours.
  • Are there any limits on how much insurance companies can pay for a customer's healthcare expenses?

    The new law bans the practice of imposing lifetime limits on how much insurance companies will pay for a customer's healthcare expenses. It also bans the practice of denying to pay healthcare costs over a certain amount each year.
  • Is preventative care covered under the healthcare reform act?

    Yes, the affordable health care act makes many preventative care appointments, tests, and treatments free. This includes things like cancer screenings and immunizations.
  • How can I find out how the new law affects me personally?

    You can talk to your employer and doctor to find out exactly how the new law affects you.

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