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Health care reform bill vs. individual insurance buyers

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Here are some common questions raised by those who buy insurance themselves. The answers come from the White House, but are slightly edited for a better presentation without altering the messages.

In short, If you buy health insurance yourself, you have access to new insurance choices in the same insurance marketplace where all members of Congress will buy their insurance. New protections are now in place to prevent insurance company abuses and tax credits are to be given to make coverage more affordable.

Will I pay more than I am paying today?

A: No. 

Under the new health care reform bill, you will likely pay less---perhaps much less.  If you buy insurance coverage on your own, premiums are expected to drop by 14 to 20 percent compared to what you paid in the past. If you get coverage through your employer, premiums could decline by up to 3 percent.

Additionally, many Americans buying health plans in the individual market now qualify for tax credits that reduce their premiums by an average of nearly 60 percent – and they will get better coverage than what they did before the law is enacted.

Will I have to pay higher co-pays and deductibles?

A: Highly unlikely.  

Health insurance reform bill limits what you have to pay out of pocket, a protection that did not exist before the law comes into existence.  And for the first time, no one will be required to pay more than a set percentage of their income on health care coverage.  And, if you like the coverage you have today, you can simply keep it.

Can I still see specialists?

A: Yes.

Under the health insurance reform bill, you have more secure and comprehensive insurance coverage. All health plans in the exchange are required to provide a package of essential benefits --- a guarantee that is not available in the past --- and the package will include preventive services at no cost.  

Consumers shopping in the exchange will choose from options that provide different levels of cost-sharing so that they can pick a health plan that best meets their needs and financial circumstances.

Will I be able to challenge coverage decisions by my insurance plan?

A: Yes.

Every insurance plan is now required to have a process for resolving disputes around your benefits and insurance coverage, and you can appeal any plan decisions that you disagree with to an independent appeals process.

Beyond that, States will receive support to set up independent offices to assist consumers with filing insurance complaints and appeals.

What are you going to do about all the confusing forms I have to fill out?

A: Make it simple.

The health care reform bill requires plans to use clear and plain language on insurance forms so that policy-holders can easily understand what benefits and what doctors are covered in your plan. 

And, standardized forms will be used to reduce the confusing and overwhelming paperwork that all Americans have to confront in the past.

What will happen if my insurance company raises my rates?

A: The new law requires public disclosure of the percent of premiums applied to overhead costs, so that you can decide whether or not you are getting the best value for your premium dollars. 

If your insurance company spends too much of your premium dollars on overhead, such as big salaries, administrative costs and marketing, they will be required to give you a rebate. 

Until the insurance exchange marketplace is up and running, there will be a process for annual reviews of all requested increases in premiums.  Insurance companies that raise rates arbitrarily will not be allowed to sell policies in the new insurance marketplace.   This process continues even after the Exchange is up and running.

What consumer protections will I get this year if I buy coverage in the individual market?

A: Beginning in September 2010,  insurers will be prohibited from placing lifetime limits on what they will pay for your medical care, and they can only apply restricted annual benefit limits. Insurers will no longer be able to arbitrarily cancel your insurance policy when you get sick, except in cases of fraud.

Insurance companies will be prohibited from denying coverage to children with pre-existing conditions. This applies to all new plans in the individual market. 

Beginning in September 2010, all new individual market health plans must provide coverage for preventive services.  Recommended prevention and vaccination services will be covered without any deductibles or copayments. They must also have a straightforward and independent appeals process so you can appeal decisions by your health insurance plan.

Beginning on January 1, 2011, insurance companies will be required to spend most of your premium dollars on your care, not on profits and overhead -- 75 percent in the individual market -- and rebate any excessive overhead to enrollees.

Similarly, starting in plan year 2011, companies that sell insurance in the individual market that jack up rates will have to disclose requested premium increases publicly.  If that rate increase is found to be unreasonable, the insurer may be prohibited competing for your business in the new state-based exchange that will begin operating in 2014.

I’m a parent, how will reform affect coverage for my children?

A: You can get coverage for your child if he or she has a pre-existing condition, and adult children can stay on family policies until age 26.

Beginning in September 2010, it will be illegal for health insurance companies that cover children to deny coverage to your child based on a pre-existing condition.   This applies to all new employer plans, new plans in the individual market, and existing employer plans.

Beginning in September 2010,  insurers will be required to permit children to stay on family policies until age 26.  This applies to all plans in the individual market, new employer plans, and existing employer plans, unless your adult child has an offer of coverage through his or her employer.  This requirement will take effect the next time your plan comes up for renewal.  Adult children who are on their parents’ plan now but who lose that coverage when they graduate from college will have the option of rejoining their parents’ policy in the new plan year beginning n September 2010.  Those whose parents work at self-insured companies will also be eligible if they do not have an offer of employer-sponsored insurance.  Both married and unmarried dependents qualify for this dependent coverage.  Beginning in 2014, children up to age 26 can stay on their parent’s employer plan even if they have an offer of coverage through their employer.

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Subscribe to comments feed Comments (21 posted):

Billy Wilson on 04/12/2010 11:15:08
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This is pure BS. Propaganda from the anointed one.
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Brian on 04/12/2010 11:21:05
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My rate is going up 21% due to the bill where did you find your miss information?
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Michael D. Engle on 04/12/2010 11:27:14
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I am very happy about the Health Care Bill passage. I am encouraged that we finally have a gov. that appears to care about people instead of war. I am very happy that George W. Bush turned me into a Democrate.
I would like to see all registered Republicans refuse their Social Security and Medicare payments and make their protest voices heard. I agree that they should not be forced to have help that they don't want. They should have freedom of choice. If the republicans were removed from all gov. benefit programs this would help the national debt a great deal. It would also allow them to feel like pure capitalists.
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Barbara H on 04/12/2010 11:30:10
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My insurance premiums just jumped 35%. That was after they jumped 30% the previous year - requiring that I raise my deductible to $5000.00. And I only used my coverage for preventative service -ever! I have not yet seen any benefit from the "new" health care either.
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cathy t on 04/12/2010 11:48:57
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I have been self employed for a long time and one reality I had to face was that my health insurance could be either pulled out from under me when I needed it most or the rates deliberately escalated so that I would have to drop the policy. While I would still like to be able to choose a good public option on the exchange I am grateful for the relief from worry this bill has given me. Just wish we could move up the start date on the exchanges. Also without this bill we would have all continued to be at the mercy of the insurance companies' drive to up profits and compensation without regard for the collateral damage it was having on our nations health and well being. Thank you Mr. President and all who voted for this bill.
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Stefan on 04/12/2010 11:50:39
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I have to wait that long for the law to take place? 2014!! So I take it the insurance companies are doing what the credit cards companies did before the credit card act became effective. such is life! I have put up with high rate for this long... 2 more years (I hope) will not kill me.
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terry medeiros on 04/12/2010 11:55:39
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The people commenting on this site are morons. The only reason rates are increasing now is because the new plan doesn't go into effect until september and these safeholds that should have been in place decades ago aren't up yet. Rates will go down because they won't be able to make excessive overhead. The large companies aren't going to be able to make the money they are making now. They know that and that's why they are increasing rates before they are forced to decrease rates again. Anyone who doesn't like the new laws are ignorant.
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m. bain on 04/12/2010 12:08:13
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PLEASE -- if you cannot spell or write a complete sentence, learn how.... the ignorance of the English language makes me NUTS.
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PCL on 04/12/2010 12:08:45
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This is all just so f'ing wonderful; all our health care troubles are over! I think the US government should build on this "success" by mandating the following:
1. That all employers pay EACH of their workers at least $150,0000 per year.
2. That all fast food restaurants be required to sell only items that make people thinner, stronger and more sexually potent, yet still taste like deep fried, cholesterol loaded lumps of bacon.
3. That all woman's jeans sold anywhere make their wearers look thin and fit.

If the government would just GUARANTEE these things, we'd have a happy, healthy nation.
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gerry on 04/12/2010 12:17:01
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I agree with the person who wrote that all republicans should drop their social security and medicare and let them buy insurance them seves...what a great country this would be..
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Nate on 04/12/2010 12:19:17
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Well put Billy.

My rates went up as well.
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to Engle on 04/12/2010 12:21:59
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Engle -

Your argument is not well reasoned.

Allow them to opt out of paying <b>and</b> receiving benefits, and you'll see the whole farce crumble. To take money from them and ask them to refuse receiving any form of it back is simply ignorant.
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Dan Smith on 04/12/2010 12:30:17
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Your rates went up because the bill largely doesn't take effect until 2014. In the meantime, insurance companies, unregulated as they now are, will gouge you as much as they possibly can in what should be an all too obvious attempt to line their dirty pockets for massive short term gains.
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Barry on 04/12/2010 12:35:16
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Let me get this straight. Obama's health care plan will be written by a committee whose Chairman says he doesn't understand it, passed by a Congress which hasn't read it, signed by a President who smokes, funded by a Treasury Chief who did not pay his taxes, overseen by a Surgeon General who is obese, and financed by a country that is nearly broke.
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Jeffrey Arnold MD on 04/12/2010 13:06:36
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This article is clearly slated and biased. Health insurance rates will increase...and by quite a bit.

Somebody has to pay for this and who do you think it is? Us! The notion of someone being able to buy insurance when they feel they need it is preposterous.

Our president is showing his true intentions and doesn't have a clue as to what is going on.
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BR on 04/12/2010 13:09:36
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"Will I pay more than I am paying today?

A: No. "

LIE! Who wrote this third grade article?
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Kathy on 04/12/2010 15:15:34
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Pleeeease!! To the people bitching about their rates going up - my insurance premiums, copay's, etc have been going up every year for the past few years. To say it's all because of the new HP bill is a bunch of BS!
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John Smith on 04/12/2010 15:54:48
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It's times like this I'm glad I live in Canada. With my government provided healthcare I can get an appointment with my doctor today, and (if I needed to) get a referral to whatever specialist I want. And all I have to pay are taxes comparable to what you guys in the states pay.
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Dude on 04/12/2010 16:28:05
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John, how much do you pay in Canadain taxes? Better yet, if someone earns $50k a year, how much do they pay in income tax. Then include sales and property tax. I am trying to figure out where all this money comes from.
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Deborah on 04/13/2010 13:55:25
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Mr Billy Wilson is willfully ignorant. Such people hold onto their inaccurate information in the face of facts, which he probably got from Rush or Palin or the other blowhard liars who are using Wilson's ignorance to fatten their pocketbooks. Wake up and begin thinking for yourselves.
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kirk wilkinson on 04/13/2010 19:47:39
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What's the big fuss? We are paying for it already, now all the costs will be in the open. Heavan forbid that we should want all our fellow citizens benefiting from equal health care coverage. What's wrong with expecting each citizen to accept to their best ability responsibility for their healthcare. The only reason that we did not get 'single payer' was because the Democrates serve the same paymaster as the Republicans - Corpporate America. Don't worry, the insurance industry is going to make out just fine, they are going to be more powerful than ever. Just like our friends on Wall Street. It's ironic that it took the Democrates to pass a Republican health care bill. As Ronald Reagan instructed "don't worry be happy"
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