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The Affordable Care Act: What It Means for Seniors

Most of the Affordable Care Act, passed in March 2010, will not go into effect until 2014. But several of its benefits have already gone into effect, and there’s plenty in the act that will benefit seniors and their families. Here’s an overview of changes in the Act that are already in effect—and may be helping you or someone you know.

Broader coverage for preventive care

The Affordable Care Act seeks to encourage preventive care—as one way of both improving care and keeping medical costs down. Anyone under Medicare Part B is eligible for such benefits as free annual wellness exams, immunizations, mammograms, and other important screenings. People with employer-sponsored health plans may also be eligible for these benefits.

Healthcare Workers

Better coverage for pre-existing conditions

Under the old rules, if you had a pre-existing condition, you were on your own. Now, adults who have health problems and who have been uninsured for at least six months can buy insurance through the federal Pre-Existing Condition Insurance Plan in their state. It’s also illegal, currently, for health insurance companies to refuse coverage to minors based on pre-existing conditions. In 2014, that rule will be expanded to include everyone. In addition, insurers will no longer be able to charge higher costs because of gender or medical requirements specific to gender, such as childbirth.

The “Doughnut Hole” got smaller

The infamous “Doughnut Hole,” the gap in coverage for prescription drugs under Medicare Part D, will now be a bit smaller. Anyone who falls into this gap automatically gets a 50% discount on many brand-name prescription drugs as well as a 14% discount on generics starting in 2012.

Less likelihood of cancellation

Insurers—even perfectly legitimate companies—often try to deny payments for expensive medical care by going through the patient’s original application with a fine-tooth comb, looking for even the smallest reason to rescind coverage. Leaving out an extremely minor health issue—like acne—or making an unintentional mistake on your application could be grounds for cancellation of your policy. Under the new law, insurers cannot rescind coverage this way. As long as you’re current on your premiums, you keep your health insurance.

In addition, if your insurer does reject your claim or cancel your coverage, you get the right to appeal to an outside panel that can decide your case. The insurance company, under the new laws, must abide by the panel’s decision.

No lifetime limits

Under the new law, the limits insurers pay over the span of a person’s lifetime in essential medical benefits will rise. This is currently in effect across all insurance policies. In the past, the limit for many insurers was around 700,000. In 2012, insurers are required to pay a minimum of $1.2 million in medical expenses. In 2013, that limit will increase to $2 million. And in 2014, there will be no limit at all to the amount of coverage insurers must pay.

Coverage for adult children

In the past, most adult children were completely on their own for health insurance after graduation or after turning 18 or 23, depending on the state. Parents could not keep an adult child on a plan, even if they had no source of coverage after graduating. Today, thanks to the new health care law, adults can stay on their parents’ plans up until the age of 26—even if they are not officially dependents of their parents.

Stronger protections for residents of nursing homes

Under the new law, nursing homes must disclose who owns the home, how much is spent on resident care vs. administrative expenses, how many hours of care residents can expect, the turnover rates of staff, and the complaints and violations on record.

States are required to maintain a website detailing this information, and you can also find it on Medicare’s Nursing Home Compare Website, where you can also see an overview of resident rights, a standardized complaint form, and links to state-specific nursing home pages. You get an easier process for filing complaints against nursing homes, and states have the option of participating in a new national program that funds expanded criminal background checks for nursing home employees such as assisted-living care providers and home health aides.

Insurance coverage is a tricky topic for many people—and for some, it’s not easy to get coverage. But under the Affordable Care Act, it’s easier to find and keep coverage—and there are some new protections for patients of all ages and specifically seniors. Hopefully the new law will not only help cover millions more Americans, but improve the health coverage of those who already have it.