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The U.S. Department of Health and Human Services (HHS) on Feb. 27 issued a final rule that implements five key consumer protections from the Affordable Care Act, and makes the health insurance market work better for individuals, families, and small businesses.
“Because of the Affordable Care Act, being denied affordable health coverage due to medical conditions will be a thing of the past for every American,” said HHS Secretary Kathleen Sebelius. “Being sick will no longer keep you, your family, or your employees from being able to get affordable health coverage.”
Under these reforms, all individuals and employers have the right to purchase health insurance coverage regardless of health status. In addition, insurers are prevented from charging discriminatory rates to individuals and small employers based on factors such as health status or gender, and young adults have additional affordable coverage options under catastrophic plans.
The final rule implements five key provisions of the Affordable Care Act that are applicable to non-grandfathered health plans:
Guaranteed Availability
Nearly all health insurance companies offering coverage to individuals and employers will be required to sell health insurance policies to all consumers. No one can be denied health insurance because they have or had an illness.
Fair Health Insurance Premiums
Health insurance companies offering coverage to individuals and small employers will only be allowed to vary premiums based on age, tobacco use, family size, and geography. Basing premiums on other factors will be illegal. The factors that are no longer permitted in 2014 include health status, past insurance claims, gender, occupation, how long an individual has held a policy, or size of the small employer.
Guaranteed Renewability
Health insurance companies will no longer refuse to renew coverage because an individual or an employee has become sick. You may renew your coverage at your option.
Single Risk Pool
Health insurance companies will no longer be able to charge higher premiums to higher cost enrollees by moving them into separate risk pools. Insurers are required to maintain a single state-wide risk pool for the individual market and single state-wide risk pool for the small group market.
Catastrophic Plans
Young adults and people for whom coverage would otherwise be unaffordable will have access to a catastrophic plan in the individual market. Catastrophic plans generally will have lower premiums, protect against high out-of-pocket costs, and cover recommended preventive services without cost sharing.
In preparation for the market changes in 2014 and to streamline data collection for insurers and states, the final rule amends certain provisions of the rate review program. And, HHS has increased the transparency by directing insurance companies in every state to report on all rate increase requests. A new report has found that the law’s transparency provisions have already resulted in a decline in double-digit premium increases filed: from 75 percent in 2010 to, according to preliminary data, 14 percent in 2013.
In addition, today the U.S. Department of Labor announced an interim final rule in the Federal Register that provides protection to employees against retaliation by an employer for reporting alleged violations of Title I of the Act or for receiving a tax credit or cost-sharing reduction as a result of participating in a Health Insurance Exchange, or Marketplace. Additional information is available at www.dol.gov/opa/media/press/osha/osha20130327.htm orwww.osha.gov.
For more information on how this final rule helps create a better health insurance market for consumers, visit cciio.cms.gov/resources/factsheets/marketreforms-2-22-2013.html.
For information on the rights and protections guaranteed by the health care law, visit healthcare.gov/law/features/rights/.
For the full text of the proposed rule, visit ofr.gov/OFRUpload/OFRData/2013-04335_PI.pdf.
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NancyMarch 01, 2013 - 1:36 am
As long as insurance companies are allowed to factor rates on age, health insurance will remain unaffordable. Notice how it is ok to discriminate against age but not gender.
Tom GibneyMarch 04, 2013 - 5:22 pm
WOnderful! So my BlueCross is going up 20% becasue of Obamacare...Am I supposed to ditch it and sign on with Govt healthcare plans?? COme on!! LIke the Governmentknows anything about running a business! Whiskey Tango Foxtrot! Thank you to all of you who voted for Obama twice! Perhaps you are too ignorant to realize you have screwed yourselves and the rest of the country. "Affordable Healcare" MY ASS!
Tom GibneyMarch 04, 2013 - 5:26 pm
BY my bad typing...you can tell I am not at all happy with the "Affordable Healthcare Act" Wrong time to push this crap through when the economy is fragile and headed toward sthe crapper. Thanks again !
DB SmithMarch 04, 2013 - 6:48 pm
Get your free health care here in America. Get your free college education here in America. Get your free food stamps here in America. Get your free phone in America. Get your free housing here in America. Get your totally free ride right here in America. The minimum requirements are that you vote Democratic, don't work and or you are here illegally. Congratulations - COME ON DOWN!
Same ole BSMarch 04, 2013 - 7:32 pm
Nancy, I sure did notice the age discrimination! Gibney, is your BlueCross really going to go up 20%! Like voting for Bush twice provided anything positive to the U.S. growth or well being. Many died needlessly and had a huge hand in the destruction of our economy. Get your head out of your bigoted butte. DB, you did not go to college, so no need there. You live with momma, so no needs anywhere!!
Tom GibneyMarch 04, 2013 - 7:42 pm
Same Ol Bs...your momma pay for your healthcare or are you getting it free? You obviously are not familiar with paying for anything for all you can do is parrot the liberal line...Blame it on Bush. Try paying attention to something other than MSNBC and FOX, you might learn something. Better yet try thinking for yourself.
DB SmithMarch 04, 2013 - 7:44 pm
@ Same ole BS.. Did you take what I said in a negative way? What could possibly be wrong with getting all that FREE stuff. The truth hurts doesn't it cumquat?
Phil VeerkampMarch 04, 2013 - 7:52 pm
Same ole BS, they ought to do it like AAA. - The older it is the less it costs. But that thing about AAA not accepting pre existing conditions really hacks me off. Not fair. Perhaps the next Messianic POTUS will get me sum single payer auto insurance. Keep'in hope alive . . .
Phil VeerkampMarch 06, 2013 - 12:24 pm
Bottom of page - left side - audio link - slide to 10 minutes inLINK - Every hospital has a Chargemaster, 20,000 list prices; no one know s how they're set. Ins co's negotiate a reduced pries, sometimes more than 50%. . . . . The middle class [victim], which I call a "mark," is billed up to three of four times actual cost.
James E.March 06, 2013 - 1:18 pm
Phil, the Chargemaster is simply fraud on the consumer. But, what politician will fight it considering the under the table payments from lobbyists? Update on Mr. Fred. He has lymphoma, but not the aggressive type. He now lacks a spleen, and his chemo starts next week. We may have him for two more years. The wonder of doggy medicine.
EvelynMarch 06, 2013 - 1:32 pm
"Marks"? Recently an acquaintance tripped, injuring his knee and elbow. At Marshall Hospital he was seen to by emergency services. TOTAL TIME AT MARSHALL: 2 hours. SERVICES: a) X-rays of affected areas. b) Advised by doctor that nothing was broken and sent him home with pain meds. BILL FOR SERVICES: $7,000.
James E.March 06, 2013 - 1:48 pm
Evelyn, pure greed and the reason health care costs continue to go out of sight. But, who will curb such excess given lobbyists? No one, so guess we will just have to enjoy the best health care in the world (that is, if you have $7,000 for a visit that more properly is billable around $500). In response to the pain of the $7,000 bill for your acquaintance, the Congress is now discussing raising the Medicare age requirement (nothing from them about investigating hospital billing). The recent article in Time is an excellent review of why our hospitals charges are so tainted. The article will be soon forgotten.
EvelynMarch 06, 2013 - 1:57 pm
James: The $7,000 bill from Marshall Hospital is shocking beyond belief and for the recipient is quite unaffordable. I am hoping he fights it tooth and nail. My personal instructions to anyone within earshot: If you ever take me to hospital for any reason whatsoever, know that the bill will be your own.
Phil VeerkampMarch 06, 2013 - 2:22 pm
Evelyn, listen to the audio.