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Health Care Reform: What Do I Need to Know Now?

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By: A. Paul Holdren
June 18, 2013

This is the first in an educational series about Health Care Reform from Blue Cross of Northeastern Pennsylvania.

The Affordable Care Act, or ACA, which is commonly referred to as Health Care Reform, was signed into law by President Obama in March 2010.  And one year ago, on June 28, 2012, the United States Supreme Court issued its landmark decision upholding the ACA provision that requires the purchase of health insurance, thus allowing all provisions of Health Care Reform to move forward as scheduled.

But if you’re still uncertain about what Health Care Reform means for you, you are not alone. A recent poll by the Kaiser Family Foundation found that much of the public remains confused about Reform, with 4 in 10 Americans unaware that the ACA is the law of the land.

What’s important for you to know right now?  Let’s start with the basics.

The Affordable Care Act was intended to help more people access and afford health care coverage regardless of their health status.  The law creates fundamental changes in the way health insurance options are developed, priced and offered to consumers.

While many parts of the law won’t take effect until the start of 2014, the following provisions are already in place:

Health care coverage for children with pre-existing conditions

  • If you have a child under 19 with an illness or disability, often called a “pre-existing condition,” he or she cannot be denied coverage.  Before the law was put into place, health plans could in some situations refuse to offer coverage or could limit benefits because of a pre-existing condition.

If you have children under age 26, they can stay on your insurance plan

  • Parents can add or keep children on their plans until they reach age 26. Your child can stay on your plan even if they are not living with you, and even if they are eligible to enroll in their own employer’s plan, unless your plan is grandfathered.

Insurance coverage cannot be cancelled if you get sick and have previously made an unintentional mistake on your application

  • Health plans cannot rescind, or cancel retroactively, your insurance coverage if you or your employer made an honest mistake on your application. Coverage can only be rescinded in cases of fraud or intentional misrepresentation.

No lifetime limits on coverage and restricted annual limits

  • The law prohibits lifetime dollar limits on coverage and also restricts and phases out the annual dollar limits a health plan can place on most of your benefits, eliminating these limits entirely in 2014.

Direct access to OB/GYN services

  • All health plans must provide women with direct access to participating obstetric and gynecologic care providers without the need for prior authorization or referral.

No cost sharing for preventive services

  • Preventive care services are covered at 100 percent.  This means that covered individuals are not charged a copayment or coinsurance for these services as long as they are received from a provider within your health plan’s network.

The right to an internal and external appeal of health plan decisions

  • Consumers have the right to appeal decisions made by their health plans, including the denial of a payment for a service or treatment.  If your plan denies payment after considering your appeal, the law gives you the right to have an independent organization conduct a medical review of that decision.

As you can see, many of the law’s provisions have already been put into action, but the most transformational aspects of Health Care Reform will take effect in 2014.  In the meantime, it’s important that you learn all you can to get the most out of your health plan for you and your family.  Visit for the latest information from the U.S. Department of Health & Human Services.

Blue Cross of Northeastern Pennsylvania is committed to sharing critical information about Health Care Reform.  Now that we’ve looked at what’s already taken effect, watch for the next installment of this series in July to learn more about what’s changing next, and when.  And visit anytime for more resources that can help you understand what Health Care Reform means for you.

A. Paul Holdren is Senior Vice President and Chief Sales & Marketing Officer for Blue Cross of Northeastern Pennsylvania.