Impact of Healthcare Reform on Insurance Plans
If the Affordable Care Act (ACA) is upheld by the Supreme Court later this month, many existing health plans will be required to enhance health insurance benefits by early 2014 to comply with the new regulations. The law will require basic or essential health benefits be offered to all insured. According to the journal Health Affairs, more than half of the current health plans do not offer the basic requirements and will have to be enhanced in order to comply.
Under the new standards of the ACA, consumers will not only be entitled to additional health plan benefits, but will also pay lower out of pocket costs; however, the new expansive benefits will not come without an increase in premiums. Under ACA, there will be four types of insurance plans offered through the insurance exchanges: bronze, silver, gold and platinum. Using the bronze plan as the benchmark, Health Affairs found that most of the health insurers will have to increase the basic coverage, more specifically in the following areas:
- Annual out of pocket costs will be capped at $6,050 for an individual or $12,100 family;
- Maternity coverage will be required to be covered; and
- Eliminate an insurer's ability to refuse to offer coverage for individuals with pre-existing conditions.
It is hard to tell how much premiums will increase due to the new regulations; estimates are in the 6-7% range. The increase will most likely occur because patients with pre-existing illnesses will now be able to purchase insurance, which should drive the total costs upward.
This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, trusts and estates, Social Security and general legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him atMlamagna@nyandctlaw.com, call him at 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.