September 22, 2010
REID: HEALTH REFORM LAW IMPROVES COVERAGE AND LOWERS COSTS FOR NEVADANS
Washington, D.C. – Nevada Senator Harry Reid today highlighted the provisions of the health insurance reform law that take effect tomorrow. In addition to the several provisions that have already been put into place, Nevada patients will now have new consumer protections for plan years beginning on or after September 23, 2010. Starting tomorrow, insurance companies will be banned from rescissions, the unfair practice of being dropped from insurance coverage when you get sick. Insurers will no longer be able to put lifetime limits on the amount of coverage they provide and their use of annual limits will be restricted until they are banned altogether in 2014. Two of Nevada’s biggest coverage providers, United Health Care and Blue Cross Blue Shield, have already implemented some of these provisions in advance of tomorrow’s deadline, including the ban on denying coverage to children because of pre-existing conditions, and the extension of coverage for young adults up to the age of 26 on their parents’ plans. In addition, under the new law, Nevadans who purchase or join a new policy will have access to free recommended preventive screenings, improved options for appealing insurance company decisions, the right to choose their own doctors, and protections against higher charges for out-of-network emergency room visits.
“Health reform was signed into law just six months ago and Nevada families are already starting to see the benefits,” said Reid. “Starting tomorrow, Nevada families will have more new protections against insurance company abuses and consumers will benefit from better coverage of preventive services. Seniors are already getting help to cover increased prescription drug costs because of the doughnut hole, and as we learned yesterday, they will have similar choices with lower premiums in the Medicare Advantage program for next year in addition to the increased preventive benefits provided for in the law. Small businesses are already eligible for tax credits to help provide coverage for their employees, and after tomorrow, those with chronic illness can rest easier knowing they won’t fall victim to lifetime or restrictive annual caps. These reforms are only the beginning of the changes that will improve coverage, reduce costs and ensure Nevada families stay healthy.”
The provisions going into effect for plan years starting on or after September 23 are:
• Extended Coverage for Young Adults: Young people will be allowed to stay on their parents’ health insurance plans until they turn 26 years old if they are not offered coverage at their own jobs.
• Free Preventive Care: All new health insurance plans must cover certain preventive screenings like mammograms and colonoscopies without any out-of-pocket costs such as deductibles, co-pays or coinsurance.
• Insurance Companies Prohibited from Rescinding Coverage: Insurers will not be able to rescind coverage or deny payment for services when a patient gets sick.
• Improved Options for Appealing Insurance Company Decisions: Consumers in new plans will have guaranteed rights to appeal insurance company decisions to an independent third party.
• Removes Lifetime Limits on Coverage: Insurance companies will be prohibited from setting lifetime dollar limits on the amount of coverage they provide.
• Regulates Annual Limits on Coverage: Insurance companies are restricted on their use of annual dollar limits on the amount of insurance coverage a patient can receive. In 2014, insurance companies will be banned from imposing any annual dollar limits.
• Children Cannot be Denied Coverage Based on Pre-Existing Conditions: Insurance companies are no longer allowed to deny coverage to children under the age of 19 due to a preexisting condition.
• Choice of Doctors: Consumers in new plans will have the right to choose their own primary care doctors from any participating provider and to designate any participating pediatrician as a child’s primary care provider. Under the law, plans will be prohibited from requiring a referral for obstetrical or gynecological care.
• End to Restrictions on Emergency Room Care: Insurance companies will be barred from charging higher cost-sharing for out-of-network emergency care.
Health reform has already been working for Nevadans as a number of provisions of the law have already become effective:
• A Pre-Existing Condition Insurance Plan (PCIP) is available to those who have been uninsured for at least six months and denied coverage due to a pre-existing condition.
• New screening procedures have been put in place to prevent fraud and reduce the costs of Medicare, Medicaid, and CHIP.
• Seniors in Medicare’s prescription drug doughnut hole are receiving checks to help cover drug costs.
• An increase in federal assistance has helped Nevada’s Medicaid recipients get the care they need, and is helping the state close gaps created by the state budget crisis.
• Nevada applied for and received $1 million to help review private insurance rate increases to ensure that they are merited.
• More than 30,000 small businesses in Nevada are eligible for tax credits that will help them provide insurance for their employees.
• And other Nevada businesses have been approved for financial assistance in providing coverage to early retirees.
For Nevada seniors who rely on Medicare the new law means new benefits next year, no loss of existing benefits, free preventive screenings and a free annual wellness visit. The new law is stabilizing the financial security of Medicare and ensuring it works more efficiently by eliminating waste and fraud in the system. The law is also closing the Medicare Part D prescription drug doughnut hole. To date, three rounds of $250 Medicare rebate checks have been mailed to Nevada seniors who have reached the doughnut hole to help cover the cost incurred by the coverage gap. Nearly 5,000 Nevada seniors have already been helped by these tax-free checks. The next step in closing the doughnut hole will come next year when seniors will be eligible to receive a 50 percent discount on brand name medications. Another way health reform is helping Nevada seniors is through lower costs and protected benefits. Yesterday, the Centers for Medicare and Medicaid Services released the new plan options for seniors enrolled in Medicare Advantage and Medicare Part D, showing similar options and lower premiums on average for Medicare Advantage plans.