What to expect from health care reform if you buy a new individual policy today

 

Our customer service representatives at Blue Cross Blue Shield of Michigan are getting lots of questions from members who buy individual plan coverage asking about changes in store from health care reform.
We take a look at some of those changes as we conclude our week-long series exploring what reform means to you.

Q: If I enroll in a new policy today, what benefits can I expect based on the language in the Patient Protection and Affordable Care Act?
A: If you bought a new policy after March 23, 2010 in the individual market, some things appear unlikely to change until your next new plan year begins,. At that point, the following changes occur:
  • No lifetime limits on your policy
o   Your policy will no longer have a lifetime dollar limit for benefits.
  • Restrictions on allowable annual limits on your policy
o   The Department of Health and Human Services will post regulations about what annual limits health insurers will be allowed to place on benefits.
  • No pre-existing condition exclusions for children under 19
o   Note: The Department of Health and Human Services has clarified this to mean that health insurers can no longer reject children under the age of 19 based on a pre-existing condition. The Michigan Blues have long followed the same policy.
o   Pre-existing condition exclusions are still permitted for persons over the age of 19.
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  • Coverage of dependents until their 26th birthday
o   The Department of Health and Human Services will post regulations about the definition of “dependent.” Currently, the only requirements are that the person must be under the age of 26 and cannot have an offer of coverage from their employer (the dependent can be married).
  • Coverage of select preventive services without any cost-sharing
o   The Department of Health and Human Services will post regulations outlining which services must be covered without cost-sharing.
Starting in January 2014, other changes will occur:
  • No pre-existing condition exclusions for anyone
  • Rating will be based only on age, family size, geography and tobacco use
  • Charging for age restricted so that the oldest policy holder is charged no more than three times the youngest policy holder
  • No annual limits on your policy
  • Required minimum benefits
  • Coverage for at least 60 percent of expected health care costs
Things that will not change for Michigan Blues members:
  • No health status rating – while this is required by health care reform, Blue Cross Blue Shield of Michigan never rates based on health status.
  • No gender rating – while this is required by health care reform, Blue Cross Blue Shield of Michigan never rates based on gender.

 

More on what health care reform means to you:

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