Guest Post: Guide to US Health Care Reform

Today's Guest Blogger, Kairol Rosenthal, author of Everything Changes: The Insider’s Guide to Cancer in Your 20s and 30s

Today’s guest post is by Kairol Rosenthal.  Diagnosed with cancer a decade ago at age 27, she is the author of Everything Changes: The Insider’s Guide to Cancer in Your 20s and 30s

If you live in the United States, part of your breast cancer journey likely involves managing the red tape of  health insurance.  Luckily, the US now has a new set of regulations that expand health insurance coverage. But these new rules can be pretty hard to figure out and I wanted to make them easier for all of us to understand.

I love the Campaign for Better Health Care and have used their guide adapting it slightly for cancer patients.  If you have additional questions, ask in the comment section below and I’ll make sure they get answered by an expert.

Remember, if an insurance company is not complying with these regulations, you can and should hold them accountable so you get the maximum protection and coverage guaranteed to you by law.  It could save you money and even save your life.

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Below are changes that apply to plans beginning or renewed after September 23, 2010. For many people this means the provisions actually take effect when they renew their plans in early 2011.

1.  COVERAGE FOR YOUNG ADULTS
If you’re a YA without health insurance, you can be covered under your parent’s insurance plan up until your 26th birthday. This includes YAs who are married and YAs who aren’t students.

FYI: Young adults that already have a health insurance offer through an employer may not be eligible.

2.  FREE PREVENTIVE CARE
Your insurance plan must cover preventive services and screenings, without co-pays or deductibles. Here are just a few of the preventive services and screenings most helpful to breast cancer patients. You can view the full list too.

– Mammography screenings every 1-2 years for women over 40

– BRCA counseling about genetic testing for women at higher risk
– Breast Cancer Chemoprevention counseling for high risk women
– Depression screening for adults

– Immunizations for adults – including HPV, influenza, and pneumonia
– Obesity screening and counseling for all adults
– Diet counseling for adults at higher risk for chronic disease

FYI: “Grandfathered” plans don’t have to comply with this rule. To learn more about what a grandfathered plan is visit FamiliesUSA and read the 4th item under ‘Big Picture’.

3.  NO MORE LIFETIME CAPS
Insurers are now not allowed to set limits on your lifetime benefits coverage, no exceptions. This means you will no longer have to worry about “capping out” on your coverage.

FYI: While there are no more lifetime limit caps, there are still annual benefits caps that have been raised to $750,000. These will be fully eliminated in 2014.

4.  NO MORE RESCISSIONS
Insurance companies are no longer able to cancel your coverage for unjust reasons, a practice known as rescission. Before, if an insurance company got hit with a big claim, they could find an unintentional error on your application (even from years ago) and use it as a basis to deny you coverage; not anymore. This  applies to all insurance plans.

FYI: If you intentionally commit fraud or hide something on your application, your insurance company can still rescind your coverage.

Your insurance company must give you 30 days notice if they intend to rescind your coverage, in order to give you time to appeal.

5.  RIGHT TO APPEAL INSURANCE COMPANY DECISIONS
You’ll now have the right to appeal decisions your insurance company makes about your health care (such as refusing coverage) to an independent, third-party reviewer. How this appeals process actually works will vary by state and by plan.

FYI: This doesn’t apply to grandfathered plans.

6.  NO MORE DENYING KIDS WITH PRE-EXISTING CONDITIONS
This applies for children up to age 19. So if you’ve got kids, read this one carefully. Insurers are required to provide coverage to children with pre-existing conditions, such as asthma or hemophilia. This applies to families with group plans and non-grandfathered individual plans.

FYI: Grandfathered individual plans do not have to comply with this provision (though group plans DO), and some insurance companies will no longer offer child-only policies. 

 

 

For tips on how to cope with everything from cancer and sexuality to managing medical debt check out Kairol’s blog Everythingchangesbook.com