Department of Financial Services, Consumer eViews Volume 7 Number 27
July 2, 2010
Sean
Shaw, Insurance Consumer Advocate
Navigating
the Patient Protection and Affordable Care Act (PPACA) can be a difficult task
on your own. In the previous installments of this series, the Office of the
Insurance Consumer Advocate provided consumers with information about benefits
now available, as well as changes consumers can expect in future years.
In this installment, we explore consumers’ ability to keep their current health plan. During the health reform debate, the President told Americans that if they liked their current health plan, they could keep it. He emphasized that there is nothing in the new law that would force them to change plans or doctors. Existing plans that are unaffected by health care reform are referred to as “grandfathered” health plans. “Grandfathered” health plans are exempt from the vast majority of the new insurance reforms. However, “grandfathered” plans are subject to a handful of requirements with different effective dates.
The Departments of Health and Human Services, Labor, and Treasury recently issued new regulations for health coverage, which were in place on March 23, 2010. The new rules:
The new rules preserve the ability of consumers to keep their current plan while providing new benefits, minimizing market disruption and moving toward more competitive, patient-centered health care. The new law requires that all health plans provide important new benefits to consumers; it allows plans that existed on March 23, 2010, to innovate and contain costs by allowing insurers and employers to make routine changes without losing their “grandfathered” status. Plans will lose their “grandfathered” status if they choose to significantly cut benefits, increase premiums by certain amounts, or increase out-of-pocket spending for policyholders. Consumers in plans that make such changes will gain all of the new consumer protections.
Most of the 133 million Americans with employer-sponsored health insurance through large employers will be able to maintain the coverage they have today. Large employer-based plans already offer most of the comprehensive benefits and consumer protections that the PPACA will provide to all Americans.
People employed by small businesses, as well as people who purchase their own insurance in the individual market, or who change insurers often, will enjoy all of the benefits of the PPACA when they choose a new plan. These consumers will benefit from the new competitive insurance exchanges that will be established in 2014 to offer individuals and workers in small businesses a greater choice of plans at more affordable rates.
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.asp.
Consumers who have further questions regarding the Patient Protection and Affordable Care Act should contact the Division of Consumer Services within the Department of Financial 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.