The first major provisions in the federal health reform law are about to take effect—President Obama plans to hail the 6-month anniversary of the legislation's passage by touting the new provisions as a "Patient's Bill of Rights." Starting Thursday, new or renewed policies have to extend coverage for young adults up to age 26 who want to remain on their parents' policies; they also can't exclude children with preexisting conditions. If you get diagnosed with a serious illness, you can't be dropped from your plan. Lifetime caps on coverage are also gone. What's more, preventive services like mammograms and cholesterol screenings are automatically covered and completely free. Some insurance companies say they'll stop selling policies just for children because they're worried parents will only buy a policy once a child becomes seriously ill.
How should you prepare for these changes? Carrie McLean, consumer specialist with eHealthInsurance, a company that finds individual and family plans for consumers and gives them a way to apply online, recommends the following:
1. Check your mail. If you currently have insurance, you should be notified in writing about any coverage that will be changing once you renew your policy. Most open enrollment periods, which include renewals, start in November and close in January. Your yearly coverage limit will be automatically raised to $750,000 and will eventually rise to $1.2 million a year in 2014, and lifetime limits on coverage will be eliminated—good news to those with severe health conditions like heart failure or cancer. "If you already have a plan, you really shouldn't see major changes," says McLean. And you don't need to worry if your child is already enrolled in a child-only plan, she adds, since children already enrolled can't be dropped from coverage.
2. Read the fine print describing "preventive care" services. Insurance companies are now required to cover mammograms, immunizations, yearly Pap smears and annual physicals. But coverage of a host of other services is not required, such as colonoscopies for colon cancer screening. Also not necessarily covered: family planning services like a vasectomy or insertion of an intrauterine device; weight loss counseling, and smoking cessation programs. These may be covered at some point in the future after a federal health board comes up with recommendations on mandatory coverage.
3. Watch out for rising premiums. While the health reform law makes it tougher for insurance companies to hike up premiums, they can still implement rate increases when justifiable and, yes, premiums may rise on employee group plans to absorb extras like adding in your co-workers' college-age kids.
4. Don't assume it's cheaper to add a grown child to your plan. It may cost you more to add, say, your 23-year-old daughter to your plan than to buy her an individual policy. "Our latest report shows that the average premium for individual adults ages 19 to 24 is about $107 per month," McLean says. If your premiums rise by more than that when you add a child, it may better to explore other options.