Tuesday, October 16, 2012

Q&A Health Care Reform: If You Have Commercial Health Insurance

We know health reform is big and confusing. Some parts of the law started in 2010. Other parts are rolling out over the next eight years. Texas physicians have carefully studied the law to help you understand what the changes mean to your health care.

Here are a few questions Texas patients have asked their doctors. There are many more. Please feel free to submit your questions to Me&MyDoctor.


If You Have Commercial Health Insurance

Q. What big changes can I expect?

A. Several big changes already are in effect:
  • There are no more lifetime dollar limits on what health insurance plans cover.
  • Adult children younger than 26 can be added to their parents' health policies
  • If you get sick, health plans can no longer retroactively drop your coverage because of honest errors you made in your application.
  • Health plans must spend 80 to 85 percent of their premium dollars on actual patient care versus overhead and profit. Health plans who fail to meet these benchmarks must give rebates to you and/or your employer. In fact, Texas recently received $167 million in rebates for individuals who purchased their own coverage and employers who purchased insurance for their employees.
  • Health plans must provide you simple, plain-language explanations about your coverage and how much you might have to pay.
Beginning in 2014:
  • Health plans can no longer exclude adults with preexisting conditions from coverage nor charge them more based on their health status.
  • Federal subsidies (money) will be available to eligible people who purchase a health plan through a state or federal exchange.

Q. Will health insurers cover my children's vaccinations and my mammogram?

A. Yes. Many preventive services, like vaccinations and cancer screenings, are covered. New private health plans must cover preventive care screenings recommended by the U.S. Preventive Services Task Force at no extra cost to you. This means you won't have to pay a copay or deductible.

Q. Can health insurance companies raise their premiums under the new law?

A. Yes. The Texas Department of Insurance (TDI) now has more authority to review large rate increases to individuals and employers. But if health care costs go up, premiums will too.

Q. Will the reforms increase my health care premiums?

A. Health insurance premiums were rising prior to the law. No one knows for sure how the new law will affect premiums. However, the law gives states and the federal government authority to scrutinize premium increases. To help make insurance affordable, the federal law requires every state to conduct a special review if a health insurance company wants to raise premiums more than 10 percent. This rate review by TDI will help protect small businesses and individuals who buy their own policies. TDI is supposed to announce whether the increase is acceptable or unreasonable, although it can't actually do anything to stop it.

The law also prevents health insurers from charging women higher premiums because of their gender or charging small businesses more because of the occupation or number of people employed. But this means the cost of premiums for men (who use fewer health care services) and for people in low-risk occupations may be increased.

Your doctors are very concerned about the affordability of health insurance. We plan to monitor this closely.

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