When the Patient Protection and Affordable Care Act was signed into law in March of 2010, it created a wave of change that would affect the waters of health insurance for years to come. A bit part of the Affordable Care Act has to do with both patient and consumer protection. The Affordable Care Act aims to lower the rate of uninsured Americans while increasing the quality of care and the affordability of health insurance by expanding both public and private insurance coverage. This will also reduce the costs of health care for individuals and the government. The law requires all insurance companies to cover any and all applicants with the same rates regardless of gender or any pre-existing medical conditions. One of the aims of the Affordable Health Care Act is directly aimed at the quality of the care patients receive – Quality over quantity being the goal. Here, we take a look more closely at the consumer protection aspects of the Act:
On-line Information for Consumers: The Affordable Care Act requires all insurers have a web presence which clearly outlines available polices as well as all pertinent information regarding coverage, benefits and costs. This enables consumers to better compare policies and find the one that best suits their needs.
Coverage to Children Cannot Be Denied: Insurers are not allowed to exclude pre-existing medical conditions for children under the age of 19. With the exception of those in grandfathered individual health insurance plans.
Coverage to Children Extended: Dependents – mainly children – will be permitted to remain insured under their parent’s insurance plan until their 26th birthday. This includes dependents that are no longer living with their parents, are not a dependent on their parent’s income tax returns, are no longer a student and those that are married.
Application Issues: The Affordable Care Act prohibits insurers from denying coverage on the basis of a technical mistake made during the application process.
Prohibition of Rescinding Coverage: The Affordable Care Act prohibits insurers from dropping an insured person when they become sick.
Removal of Lifetime Limits: Under the Affordable Care Act, as of September 2010, with all new policies issued, insurers are now prohibited from imposing a lifetime dollar amount on essential benefits.
Regulation of Annual Limits: Insurers ability to enforce an annual spending cap became restricted under the Affordable Care Act. These caps will be completely prohibited by 2014.
Right to Appeal against Insurance Company Decisions: The Affordable Care Act enables consumers to appeal against coverage or claims to insurance company and it will be externally reviewed.
Setting up Consumer Assistance Programs in the States: The Affordable Care Act provides for establishment of consumer assistance programs in states. The states will receive federal grant funds to help set up or expand existing independent consumer assistance offices. These offices are to help consumers deal with private health insurance issues such as filing complaints, appealing, enrolling in health coverage and helping consumers to be aware of their rights and responsibilities related to health insurance policies. It also aims at data collection and finding problems within the health care system so as to find solutions to these problems.
Cutting Down Premium on Health Care: The Affordable Care Act requires all insurance companies to use 85% of all premium dollars collected exclusively on health care services, the remaining 15% for administrative costs, overhead and profit.
Checking Over-payments to Big Insurance Companies: The Affordable Care Act will eliminate discrepancies in payments to insurance companies. It does not change the delivery of all guaranteed Medicare benefits to people enrolled in a Medicare Advantage plan. It also offers a bonus payment to Medicare Advantage plans offering a high quality care.
Strengthening Medicare Advantage: The Affordable Care Act will strengthen Medicare Advantage by offering bonuses to plans providing a high quality of health care. It focuses on quality improvement and has not curtailed any benefits offered by Medicare Advantage Plans.
Abolishing Gender Discrimination or Discrimination Due to Pre-Existing Conditions: The Affordable Care Act prohibits insurance companies from refusing to sell coverage on basis of an individual’s pre-existing conditions or gender. Insurance companies are also not allowed to charge higher premiums to consumers based on either gender or pre-existing health conditions.
Coverage for Individuals Participating in Clinical Trials: The Affordable Care Act ensures coverage for individuals participating in clinical trials. Insurance companies cannot drop or limit coverage if an individual chooses to participate in a clinical trial. This goes into effect from January1, 2014. It applies to all the clinical trials related to life-threatening diseases and illnesses.