Frequently Asked Questions on Federal Healthcare Reform

The health insurance reforms adopted as part of the Patient Protection and Affordable Care Act (PPACA), and the subsequent reconciliation bill, are phased-in over the next few years. Most provisions will not take effect until Jan. 1, 2014. However, some new protections were implemented when plans renewed after Sept. 23, 2010. In addition, a new federal high risk pool programs and transparency measures were adopted during the summer of 2010. For more information on when certain provisions become effective, see the three PPACA Charts from the National Association of Insurance Commissioners: (Immediate Implementation, Market Reforms and American Health Benefit Exchanges).

(Updated 8/4/10) The U.S. Department of Health and Human Services (HHS) along with the Office of Consumer Information and Insurance Oversight frequently issues regulations that implement many of the provisions of the legislation that address private health insurance. Find the most current information on the HHS Regulations and Guidance web page.
 

No. Health plans in effect as of March 23, 2010, are grandfathered under the law, and will be considered "qualified coverage" that meets the January 2014 mandate for health insurance.

The key goal of the health care reform law is to ensure that no one is denied coverage or priced out of coverage due to a health problem. If people wait until they have a health problem to purchase insurance, the health insurance market simply will not work. There would be a small number of very expensive choices for everyone. So, the law requires that everyone have minimum coverage, creating a larger pool of both sick and healthy individuals.

The health reform law requires that insurers and employers providing dependent coverage to children make that coverage available to adult children of enrollees up to their 26th birthday. This requirement became effective for "plan years" beginning Sept. 23, 2010, so you may enroll your child in group coverage at the first open enrollment period following this date.

If the child is 19 or older, the health plan may exclude coverage of pre-existing conditions for a period of time, as allowed by existing state and federal law until the prohibition on pre-existing condition exclusions takes effect in 2014.

This FAQ from the HHS Center for Consumer Information and Oversight (CCIIO) provides additional details on the issue.

 The health reform law prohibits insurers from excluding coverage of children’s pre-existing conditions for plan years beginning after Sept. 23, 2010. The Obama administration has issued regulations that require insurers to provide coverage without pre-existing condition exclusions to children if they cover the parents, and the health insurance industry has signaled its intention to comply with this interpretation. More information is available from the HHS Center for Consumer Information and Insurance Oversight.

Information on Colorado's child-only health plans.
 

Exchanges are the central mechanisms created by the health reform bill to help individuals and small businesses purchase health insurance coverage. Beginning in 2014, an Exchange will be established in each state to help consumers make valid comparisons between plans that are certified to have met benchmarks for quality and affordability. The Exchanges will also administer the new health insurance subsidies and facilitate enrollment in private health insurance, Medicaid and the Children's Health Insurance Program (CHIP). The federal law will not require anyone to purchase health insurance through the Exchange, though subsidies will only be available for plans sold through the Exchange. If you would rather buy your insurance through an insurance agent or broker, you will be free to do so. However, the law's intent is to make purchasing insurance through the Exchange easy to do in a matter of minutes. Information on Colorado’s exchange can be found here.
 

Pre-Existing Condition Insurance Programs are currently enrolling customers in every state. This program is operated by the federal government in states that chose not to establish a high risk pool under the federal program. Coverage is available to individuals with pre-existing conditions who have been uninsured for at least six months through high risk pool programs in every state. These programs provide coverage that immediately covers pre-existing conditions at premiums that are capped at the average cost of private coverage in your state's individual market.

Colorado's pre-existing condition insurance program, GettingUSCovered," is accepting uninsured Coloradoans.

In 2014, when the Exchanges open for business, insurers will be prohibited from discriminating against individuals with pre-existing conditions in offering or pricing health insurance policies. In addition, for those with qualifying incomes, subsidies will be available to reduce premiums and cost-sharing for plans purchased through the Exchange.

Beginning in 2014, those earning less than $10,830 will be eligible for their state’s Medicaid program. They may also purchase coverage through the Exchange, though they will not be eligible for subsidies.

Beginning in 2014, low- and moderate-income individuals and families whose employers do not subsidize health insurance coverage will be eligible for subsidies that enable them to purchase coverage through the Exchange in their state. The amount of these subsidies, which will reduce premiums and out-of-pocket costs for deductibles, co-payments and coinsurance, will depend upon the size of your family and your household income.
 

If your insurance company "rescinds," or retroactively cancels, your health insurance coverage, it will be required, in plan years beginning Sept. 23, 2010, to provide advance notice of its intention to do so, and may only do so if you committed fraud or made an intentional misrepresentation of an important fact on your application. If your insurer notifies you that it wants to rescind your policy, and you have not done either of these things, request more information from the company. If you are not satisfied with their explanation, immediately contact your state insurance department to file a complaint. You can find contact details on our website. If you prefer, you may file a complaint online.
 

Health insurance plans that became effective after March 23, 2010, must cover certain preventive services and eliminate any cost-sharing for these services.

Yes, nothing in the legislation would infringe upon the ability of an individual to contribute to a Health Savings Account (HSA), or discourage an individual from doing so. The minimum level of coverage required to meet the individual mandate was specifically designed to allow for the purchase of a qualified high deductible plan that would complement the HSA.

Unfortunately, the grim fact is that health care spending is likely to continue rising faster than general inflation well into the future, resulting in higher premiums. While some individuals and families with health problems may see their premiums decrease significantly under the new rating rules, for most Americans premiums will continue to increase from year to year. However, the new regulations are designed to prevent unreasonable and unexpected spikes in premiums and, over time, to slow the growth in health care spending.

The total cost over 10 years is projected to be $940 billion. This is more than offset by cuts in spending and increased fees and taxes, resulting in a reduction in total spending of $138 billion over 10 years, according to the Congressional Budget Office. Time will tell if these estimates are accurate and whether the offsets materialize.