Changes to health care under the law, at a glance - Quincy Herald-Whig | Illinois & Missouri News, Sports

Changes to health care under the law, at a glance

Posted: Updated:

BY THE ASSOCIATED PRESS

An overview of some of the key changes to health care services under the Affordable Care Act:

ESSENTIAL HEALTH BENEFITS

Under the law, health insurers must cover 10 essential benefits. This will make health plans more costly, but also more comprehensive. Starting next year, the rules will apply to all plans offered to individuals or through the small-group market to employers with 50 or fewer workers. The essential-benefits requirement does not apply to plans offered by larger employers, which typically offer most of these, already.

The covered benefits are: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative services and devices; laboratory services; management of chronic diseases, and preventive and wellness services; and pediatric services, including dental and vision care.

People will be able to pick from insurance plans with differing levels of coverage and varying costs for co-pays and premiums. But insurers will have to cover a certain percentage of the services' cost.

"Most of the important services people need are covered, though there may be a slight variation (from state to state)," says Jennifer Tolbert, director of state health reform for the Kaiser Family Foundation.

DENTAL-VISION

Need a teeth-cleaning or eye exam? You still could be reaching into your own wallet to cover the cost even after the Affordable Care Act takes full effect next year. Dental and vision care is considered an essential benefit for children aged 18 and younger whose parents or guardians get insurance through the individual or small-group plans. The law does not mandate this coverage for adults, but some states could choose to have them covered.

Still, getting dental coverage for children and teenagers might be a bit complicated depending on where you live. States can choose to offer those items as stand-alone plans, and federal subsidies would not help pay for the costs.

PRE-EXISTING CONDITIONS

This is a major change under the law. Starting in 2014, most plans — whether obtained through an employer or on the marketplace — cannot deny coverage or charge more money because of a pre-existing health conditions.

However, if you have what is known as a grandfathered individual plan — a plan you buy yourself that was in existence before March 23, 2010, and has remained unchanged — then this rule would not apply. So check the details on your plan and consider shopping around.

OUT-OF-POCKET SPENDING/LIFETIME LIMITS

Under the law, the amount of money people will have to pay out-of-pocket each year for medical and prescription drug costs will be capped at $6,350 for individuals and $12,700 for a family. These limits are separate from the monthly premiums people pay. The limits take effect in 2014 for those buying insurance on the state health insurance exchanges. For those with employer-based coverage, the restrictions will be fully in place in 2015.

In addition, most insurance plans will be prohibited from setting lifetime cost limits on coverage for essential health benefits. This means your insurer cannot deny you coverage because your medical bills have gone over a certain amount.

AGE 26

One popular provision of the health care law already is part of most insurance plans — allowing young people to stay on their parents' insurance plans until age 26. This also covers dependents, including step-children, adopted children and some foster children. This benefit will be required of all plans that provide dependent care. Starting in 2014, younger people can remain on a parent's or caregiver's plan even if they have an employer option of their own.

___

Associated Press writer Catherine Lucey in Des Moines, Iowa, contributed to this report.

  • Local HeadlinesLocal HeadlinesMore>>

  • Traveling exhibit showcases Hancock County sports teams

    Traveling exhibit showcases Hancock County sports teams

    Friday, October 31 2014 12:37 PM EDT2014-10-31 16:37:29 GMT
    CARTHAGE, Ill. -- Kim Orth was in high school when Hancock County sports teams won state Class A basketball tournaments in back-to back years. Warsaw won the tournament in 1997, followed by Nauvoo-Colusa in 1998, with...
    CARTHAGE, Ill. -- Kim Orth was in high school when Hancock County sports teams won state Class A basketball tournaments in back-to back years. Warsaw won the tournament in 1997, followed by Nauvoo-Colusa in 1998, with...
  • Quincy train club to celebrate 40-year anniversary

    Quincy train club to celebrate 40-year anniversary

    Saturday, November 1 2014 2:02 AM EDT2014-11-01 06:02:38 GMT
    Forty years of locomotive excellence will be celebrated for this weekend. The Quincy Society of Model Engineers is celebrating with an open house from noon to 5 p.m. Saturday and noon to 4 p.m. Sunday at Good Samaritan...
    Forty years of locomotive excellence will be celebrated for this weekend. The Quincy Society of Model Engineers is celebrating with an open house from noon to 5 p.m. Saturday and noon to 4 p.m. Sunday at Good Samaritan...
  • Haunted house a ghoul-to place for Halloween fun in Hannibal

    Haunted house a ghoul-to place for Halloween fun in Hannibal

    Saturday, November 1 2014 1:25 AM EDT2014-11-01 05:25:59 GMT
    HANNIBAL, Mo. -- Clayton Robertson figured he would have been scaring people on Halloween night. "I would be out scaring little kids," said Robertson, a Hannibal High School freshman. Instead of terrorizing his...
    HANNIBAL, Mo. -- Clayton Robertson figured he would have been scaring people on Halloween night. "I would be out scaring little kids," said Robertson, a Hannibal High School freshman. Instead of terrorizing his...
Powered by WorldNow
All content © Copyright 2000 - 2014 WorldNow and Quincy Herald-Whig. All Rights Reserved.
For more information on this site, please read our Privacy Policy and Terms of Service and Mobile Privacy Policy & Terms of Service.