Your benefits are difficult to understand and manage in any given year. This year, with even more changes coming as a result of health care reform, it might sound overwhelming. Not only do you have to understand what’s happening with your medical plans and wellness programs, but you’ll also need to be aware of how the Patient Protection and Affordable Care Act affects you.
Well, I can help you start demystifying this complex piece of legislation and explain what it really means.
First, let’s focus on what’s happening right now. I’ve picked out some topics that are taking effect this year and the next and might have an immediate impact on you. We’ll have plenty of time later to talk about the changes in 2012 and beyond.
It is nothing new to hear about rising health care costs. If you’re enrolled in your employer’s benefits, chances are you’ll hear this fall about how health care reform is impacting costs, too. Adding more dependents onto employer plans and removing some of the limits means more costs.
New Eligibility Rules for Dependents
If you’re younger than 26, you don’t need to be enrolled in school or be financially dependent on your parents to qualify for their benefits. If you have a job that offers coverage, however, you won’t be eligible for your parents' plan. You can be married and still qualify. Your spouse or children, however, will not be eligible. You’ll be able to join your parents' plan during their next open enrollment period. For most companies, that will be sometime this fall.
Removal of Annual and Lifetime Limits Mean
Most plans share the cost of an employee’s health care expenses up to a specific dollar amount over the course of your lifetime (usually this was a number in the millions). As of Sept. 23, 2010, or the first day of the plan year, a company’s plan no longer has lifetime limits. If you lost eligibility for your company’s health plans when your health care costs reached your company’s lifetime limit, you can now re-enroll in that plan. Check with your health care provider to learn more details about re-enrolling.
Preventive Services Covered
Companies will have to cover:
- Evidence-based preventive services. Preventive services that have proven benefits, such as breast and colon cancer screenings, screening for vitamin deficiencies during pregnancy, screenings for diabetes, high cholesterol and high blood pressure. See the complete list.
- Routine vaccines. From routine childhood immunizations to tetanus shots for adults. See a list of recommended immunizations (in PDF form) for children age 0-6 , 7-18 , catch-up immunizations and adults.
- Prevention for children. From regular pediatrician visits to screenings. Click here for a complete list of recommended services.
- Prevention for women. New guidelines are expected next year.
Health Savings Accounts and Flexible Spending Accounts
A Health Savings Account (HAS) is an account in which you (and sometimes your company) contribute tax-free money that can be used to purchase health care expenses.
The new law says that HSA debit cards may no longer be used for over-the-counter (OTC) items beginning January 1, 2011. That means OTC items such as cough, cold and flu medicines and pain relievers cannot be reimbursed through HSA accounts unless the items have a doctor's prescription or other supporting document.
So what does this mean for you? If you’re using one of these accounts, you’ll have to manage your OTC costs differently.
For more information on health care reform, check out these websites: