http://www.nytimes.com/interactive/2013/10/30/us/why-some-people-cant-keep-their-insurance-plans.html?ref=politics
Despite repeated assertions by President Obama that people who like their health insurance will be able to keep it under the new health care law, many people who bought insurance on their own — a small fraction of the insurance market — will have to buy new plans. Related Article »
Medicare, Medicaid,
military coverage
Share of people with
employer-sponsored
insurance
29%
49%
Uninsured
5%
16%
Individual market
10-15 million people
Policies must meet new standards ...
Beginning Jan. 1, new policies issued must cover a
minimum share of health care expenses and offer 10 “essential health
benefits”:
1.
Outpatient care
7.
Rehabilitative and habilitative
services and devices
2.
Emergency room visits
3.
Hospitalization
8.
Lab tests
4.
Maternity and newborn care
9.
Preventive services and
chronic disease care
5.
Mental health and
substance use treatments
10.
Pediatric services, including
dental and vision
6.
Prescription drugs
... unless a plan is grandfathered in ...
If a policy was in effect when the law passed in March
2010 and has not been changed significantly, people already on the plan could
remain on it, and the plan would not have to meet the new requirements.
... but many people will need to purchase a new plan
because:
• Many plans do not currently meet the law’s standards
for coverage.
• Most people in the individual market do not keep their
policies for more than a year, so most would not be eligible to be
grandfathered.
• Insurance companies cannot change grandfathered plans
or sell them to new customers, so they have incentive to cancel the
policies.
Some people will also move to Medicaid coverage.
More than one million low-income adults currently in the
individual market will be newly eligible for Medicaid in 2014 because they live
in a state that has decided to expand the program.
Why Rates Are Increasing for Some People
The total cost of policies will be higher on average
...
Many plans offered on the individual market will have
more benefits and more consumer protections than they did before. The pools will
also cost more for insurance companies since they cannot deny people with
pre-existing conditions.
In the individual market,
on average, rates for group will:
... but people will be affected differently
...
INCREASE
DECREASE
SEX The law bans
insurers from charging women higher premiums than men of the same age.
MEN
WOMEN
AGE The law bans
insurers from charging older adults more than three times the amount they charge
younger adults.
YOUNG
OLD
HEALTH The law bans
insurers from charging people with health problems more.
HEALTHY
UNHEALTHY
... and many people will be eligible for government
subsidies.
An estimated 48 percent of people on the individual
market will be eligible for tax credits to reduce their costs, based on their
income level.
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