Navigating Health Care Reform Part II - A Summer Series

Department of Financial Services, Consumer eViews Volume 7 Number 25

June 18, 2010

In the second installment of the Patient Protection and Affordable Care Act series, the Office of the Insurance Consumer Advocate will detail the benefits consumers can expect to enjoy in future years. While the first part of this series focused on immediate benefits, the benefits in this edition have yet to take effect.

Sean Shaw, Insurance Consumer Advocate

The Patient Protection and Affordable Care Act (PPACA) of 2010 (H.R. 3590) and the Reconciliation Act of 2010 (H.R. 4872) will change current law to implement the following:

Beginning in 2011, the following provisions will be implemented:

• Consumers under Medicare will no longer have to pay co-payments for preventative services. Preventative services will also be exempt from deductibles.
• Investments will be made to increase the number of primary care practitioners, including doctors and nurses. This will allow more consumers to have access to health care.
• Medicare Advantage plans will be prohibited from imposing higher cost-sharing requirements for some Medicare covered benefits than is required under the traditional fee-for-service program.

Consumers will find that numerous changes will be enacted in 2013/2014. As a result, consumers should contact their agent health care plan, or the Department of Financial Services, Division of Consumer Services periodically in an effort to stay abreast of the various reforms.

• Insurers will no longer be able to exclude a consumer from receiving coverage based on a preexisting condition.
• The secretary of HHS and the individual states will begin approving or rejecting the insurance company rate filings.
• Insurers will be required to accept every employer and every individual that applies for coverage.
• However, an insurer may continue to restrict enrollment based upon open or special enrollment periods.
• All insurance plans will have to include the essential benefits package required of plans that will be sold in the Exchanges and will have to comply with limitations on annual cost-sharing for plans sold in the Exchanges.
• Insurers must provide coverage to consumers who participate in clinical trials.
• Groups who provide coverage will not be allowed to impose waiting periods that exceed 90 days, which should provide greater access to care for many consumers.
• Consumers with income at or below 133 percent of the federal poverty line who are not otherwise eligible for Medicaid or Medicare will be entitled to participation in Medicaid.
• Lastly, both annual and lifetime policy limits will be removed from all policies which will provide greater care for consumers.

In 2015 and beyond other reforms are expected to take place, consumers should check with their health care provider or the Department of Financial Services regarding any additional reforms.

As more information is available and additional changes become effective, the Office of the Insurance Consumer Advocate will generate advisories regarding their effect on consumers. More information regarding the PPACA can be found on the website of the Insurance Consumer Advocate at  http://www.myfloridacfo.com/ica/federalhealthcare.aspConsumers who have questions regarding health care reform can contact the Department of Financial Services, Division of Consumer Services on-line at http://www.myfloridacfo.com/Consumers/ or by phone at 1-877-MY-FL-CFO (1-877-693-5236), toll-free in Florida, and (850) 413-3089 from out of state.

The Insurance Consumer Advocate is appointed by Florida CFO Alex Sink and is committed to finding solutions to insurance issues facing Floridians, calling attention to questionable insurance practices, promoting a viable insurance market responsive to the needs of Florida’s diverse population and assuring that rates are fair and justified.