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Affordable Care Act: Improvements to Coverage and Benefits for Children

on Fri, 01/04/2013 - 4:22pm

The Affordable Care Act (ACA) provides new rights and protections for our country’s youth. 

Key features of the ACA benefitting children include:

  • No more coverage denials for children as a result of pre-existing conditions.  The ACA prohibits health insurance issuers in both the group and individual markets from imposing pre-existing condition exclusions on children under 19.  Beginning in January 2014, this benefit will extend to adults and insurers will not be able to deny coverage to anyone based on their past health history. 
  • No more annual or lifetime dollar limits on most health insurance benefits
  • Access to twenty-five preventive care services for infants, children and adolescents such as screenings, vaccinations and annual checkups with no cost-sharing   
  • Ten categories of services , called "Essential Health Benefits," are now required to be included in insurance plans to ensure comprehensive coverage for everyone.  For children, vision and dental care are included within the Essential Health Benefits. 
  • Insurance companies can no longer cancel your coverage because of honest mistakes on an insurance application
  • No more denials for medical care without being allowed to appeal
  • Parents are able to select their child’s pediatrician from among any available participating providers within the plan network
  • Childrens' eligibility for the popular Children's Health Insurance Program (CHIP), which helps lower-income families, will continue, and an extension of federal funding for the Children’s Health Insurance Plan is included within the law through September 2015.  States will not be able to make budget cuts that remove children from the CHIP program until at least 2019
  • Beginning in October 2013, parents will be able to do one-stop shopping for appropriate health coverage for children through their state’s Health Insurance Marketplace
  • Additional options are available to help make insurance affordable, including insurance tax credits for families with  lower incomes to help pay for health care premiums (starting in 2014)  and other financial assistance programs that may lower out-of-pocket costs.
  • Beginning in 2014, for children seeking to enter a clinical trial there will be enhanced coverage included within the insurance plan for ‘routine care’
  • To help consumers fully understand their health coverage, all health plans must present the details of their product in an easy to understand “uniform summary of benefits,” allowing you to easily compare coverage options during the application process and at renewal.  In addition, each plan must showcase the costs associated with two coverage examples, allowing better understanding of the potential out-of-pocket expenses related to care

Additional Changes:

  • 80 percent of enrollee premiums collected by insurance companies must be spent on patient care and efforts to improve the quality of patient care
  • Incentives for physicians to adopt electronic health records and capture and report certain quality measures
  • Provisions to detect waste, fraud, and abuse within the system, increase care coordination, review large premium increases by insurers, and to encourage improvements in the health care delivery model.  
  • Support for obesity-related services within states to help build public awareness