How will health reform affect you? And when?

The Washington State Office of the Insurance Commissioner has posted an explanation on its Web site explaining how the new health reform law will effect you and when the changes will take effect:

Washington State Capitol

“Some significant changes will take effect almost immediately; others are phased in over the next several years,” the site explains. “Most of the rules and regulations have yet to take effect that will help our state implement the reforms.”

“We’ll continue to update this page as new information becomes available, but below is a timeline of what we know so far:

Within 90 days:

People with pre-existing conditions who have been uninsured for several months can get financial assistance for coverage through Washington state’s Health Insurance Pool (WSHIP).

Washington’s Health Insurance Pool can apply for federal grants to assist in lowering premiums for people denied health insurance due to pre-existing conditions.

Within six months:

Health plans must include preventive services – with no out-of-pocket costs. Health plans can no longer include lifetime caps on benefits. (Caps of $1 million or $2 million are now common.) Insurers cannot refuse to cover a child’s pre-existing condition.

Young adults may be covered on their parents’ plan until the age of 26, unless they get a job that has employer-sponsored insurance.

Medicare enrollees cannot be charged a co-pay for preventive services.

This year:

Medicare enrollees with prescription drug coverage (Part D) will receive a one-time check of $250 to help pay for their medications in the coverage gap (“donut hole”).

Small businesses will not be required to continue coverage for their employees up until 2013, but they’ll receive tax incentives if they do. If they pay for at least 50 percent of their employees’ premiums, they can receive a tax credit equivalent to 35 percent of their contribution.

Washington state will begin applying for federal grants to implement the new health reform law.

In 2011:

Drug manufacturers must provide a 50 percent discount to Part D (Medicare’s prescription drug benefit) for brand name drugs.

In 2014:

Health plans cannot exclude coverage for pre-existing conditions.

Health plans must accept every employer and every individual that applies for coverage, although they may create special enrollment periods.

Health plans cannot require individuals to take a health questionnaire or deny them coverage because of their health condition.

Individuals and families can receive subsidies, based on their income, to help buy coverage from their state’s health insurance exchange. Also, income-based caps on out-of-pocket medical expenses take effect.

People under age 30 can purchase a comprehensive coverage plan or a catastrophic plan designed just for their age group.

Small businesses can purchase insurance for themselves and their employees through the health insurance exchange. Their tax credit will increase to 50 percent of premiums and last for two years. The tax credits are available to employers with fewer than 25 workers and average wages below $40,000 a year.

From 2014-2019, Washington state will receive $13.78 billion to help pay for health insurance coverage for the uninsured, either through subsidies for low and middle income families or through the state’s Medicaid program for the very poor.

In 2020:

The coverage gap or “donut hole” in Medicare’s prescription drug program closes.

To learn more and follow updates:

• Go to the Web site of the Washington State Office of the Insurance Commissioner and click on the Health Care Reform button:

Tags: Gov. Gregoire, Health-care Reform, Washington State

Category: Healthcare Reform