Changes to health care under the law - WFLA News Channel 8

Changes to health care under the law

Posted: Updated:

An overview of some of the key changes to health care services under the Affordable Care Act:

Essential Health Benefits

Under the law, health insurers must cover 10 essential benefits. This will make health plans more costly, but also more comprehensive. Starting next year, the rules will apply to all plans offered to individuals or through the small-group market to employers with 50 or fewer workers. The essential-benefits requirement does not apply to plans offered by larger employers, which typically offer most of these, already.

The covered benefits are: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative services and devices; laboratory services; management of chronic diseases, and preventive and wellness services; and pediatric services, including dental and vision care.

People will be able to pick from insurance plans with differing levels of coverage and varying costs for co-pays and premiums. But insurers will have to cover a certain percentage of the services' cost.

"Most of the important services people need are covered, though there may be a slight variation (from state to state)," says Jennifer Tolbert, director of state health reform for the Kaiser Family Foundation.

Dental-Vision

Need a teeth-cleaning or eye exam? You still could be reaching into your own wallet to cover the cost even after the Affordable Care Act takes full effect next year. Dental and vision care is considered an essential benefit for children aged 18 and younger whose parents or guardians get insurance through the individual or small-group plans. The law does not mandate this coverage for adults, but some states could choose to have them covered.

Still, getting dental coverage for children and teenagers might be a bit complicated depending on where you live. States can choose to offer those items as stand-alone plans, and federal subsidies would not help pay for the costs.

Pre-exisiting Conditions

This is a major change under the law. Starting in 2014, most plans — whether obtained through an employer or on the marketplace — cannot deny coverage or charge more money because of a pre-existing health conditions.

However, if you have what is known as a grandfathered individual plan — a plan you buy yourself that was in existence before March 23, 2010, and has remained unchanged — then this rule would not apply. So check the details on your plan and consider shopping around.

Out-of-Pocket Spending/Lifetime Limits

Under the law, the amount of money people will have to pay out-of-pocket each year for medical and prescription drug costs will be capped at $6,350 for individuals and $12,700 for a family. These limits are separate from the monthly premiums people pay. The limits take effect in 2014 for those buying insurance on the state health insurance exchanges. For those with employer-based coverage, the restrictions will be fully in place in 2015.

In addition, most insurance plans will be prohibited from setting lifetime cost limits on coverage for essential health benefits. This means your insurer cannot deny you coverage because your medical bills have gone over a certain amount.

Age 26

One popular provision of the health care law already is part of most insurance plans — allowing young people to stay on their parents' insurance plans until age 26. This also covers dependents, including step-children, adopted children and some foster children. This benefit will be required of all plans that provide dependent care. Starting in 2014, younger people can remain on a parent's or caregiver's plan even if they have an employer option of their own.


  • 8 On Your SideMore>>

  • Magic diet pill promoter found running new business in Tampa

    Magic diet pill promoter found running new business in Tampa

    Tuesday, September 2 2014 5:02 PM EDT2014-09-02 21:02:23 GMT
    File Photo: Nick CongletonFile Photo: Nick Congleton
    Nick Congleton is in hot water with the FTC for selling "magic diet pills," and under investigation by Florida's Attorney General for a defunct travel club that owes hundreds of consumers for vacations they never received.Now, he's keeping a low profile and running a new business out of an unmarkedwarehouse in the Channelside District, where he didn't have much to say to Eight On Your Side this morning.
    Nick Congleton is in hot water with the FTC for selling "magic diet pills," and under investigation by Florida's Attorney General for a defunct travel club that owes hundreds of consumers for vacations they never received.Now, he's keeping a low profile and running a new business out of an unmarkedwarehouse in the Channelside District, where he didn't have much to say to Eight On Your Side this morning.
  • Home Depot probing 'Unusual Activity' after reports of data breach

    Home Depot probing 'Unusual Activity' after reports of data breach

    Tuesday, September 2 2014 1:55 PM EDT2014-09-02 17:55:41 GMT
    Home Depot may be the latest retailer to suffer a massive credit card breachHome Depot may be the latest retailer to suffer a massive credit card breach
    Home Depot may be the latest retailer to have suffered a massive credit card breach, the company confirmed on Tuesday, after Krebs on Security reported that a large cache of stolen data had appeared on black market sites.
    Home Depot may be the latest retailer to have suffered a massive credit card breach, the company confirmed on Tuesday, after Krebs on Security reported that a large cache of stolen data had appeared on black market sites.
  • Community reaches out to Spring Hill family after theft of lawn equipment

    Community reaches out to Spring Hill family after theft of lawn equipment

    Tuesday, September 2 2014 8:45 AM EDT2014-09-02 12:45:21 GMT
    Michael Depace wants to say "thank you" and give a huge hug to everyone that reached out after a thief stole $3,500 worth of lawn equipment from him.
    Michael Depace wants to say "thank you" and give a huge hug to everyone that reached out after a thief stole $3,500 worth of lawn equipment from him.
  • NewsMore>>

  • Suspect who ran over Palm Harbor security guard to turn himself in says attorney

    Suspect who ran over Palm Harbor security guard to turn himself in says attorney

    Tuesday, September 2 2014 9:59 PM EDT2014-09-03 01:59:51 GMT
    The suspect was involved in an altercation inside the establishment just before 3 am Friday.The suspect was involved in an altercation inside the establishment just before 3 am Friday.
    The man who investigators say intentionally ran over a security guard at a Palm Harbor nightclub early Friday morning will turn himself in on Wednesday according to his attorney, Barry Cohen.
    The man who investigators say intentionally ran over a security guard at a Palm Harbor nightclub early Friday morning will turn himself in on Wednesday according to his attorney, Barry Cohen.
  • Online business complaint lands Sarasota woman and BBB in lawsuit

    Online business complaint lands Sarasota woman and BBB in lawsuit

    Tuesday, September 2 2014 7:46 PM EDT2014-09-02 23:46:44 GMT
    Can you be sued over your online complaint about a company? That's what happened to Sarah Kessler, of Sarasota.
    Can you be sued over your online complaint about a company? That's what happened to Sarah Kessler, of Sarasota.
  • Is your data safe in Apple’s iCloud?

    Is your data safe in Apple’s iCloud?

    Tuesday, September 2 2014 6:04 PM EDT2014-09-02 22:04:56 GMT
    Hackers gained access to celebrities private pictures including nude photos of actress Jennifer Lawrence. Apple says it has fixed a security flaw but cybersecurity experts say anyone can become a victim.“Anybody can get hacked.
    Hackers gained access to celebrities private pictures including nude photos of actress Jennifer Lawrence. Apple says it has fixed a security flaw but cybersecurity experts say anyone can become a victim.“Anybody can get hacked.
  • Sign up for WFLA News Channel 8 Email Alerts

    * denotes required fields






    Thank you for signing up! You will receive a confirmation email shortly.
Powered by WorldNow

200 South Parker Street, Tampa, FL 33606

Telephone: 813.228.8888
Fax: 813.225.2770
Email: news@wfla.com

Can’t find something?
Powered by WorldNow
All content © Copyright 2000 - 2014 Media General Communications Holdings, LLC. A Media General Company.