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Insurance Regulation Changes That May Affect You

Created: 03/02/2012
Last Updated: 08/26/2013

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Today, rates, benefits and coverage limits can vary considerably from one health insurance policy to another and can be changed without warning. This is one of the many factors that have contributed to higher health care costs. Many people also are denied insurance coverage or can't afford it because they have certain conditions or traits that affect their ability to get insurance.

As part of the Patient Protection and Affordable Care Act (ACA), approved by Congress and signed into law in 2010, insurers receiving federal money will not be able to discriminate based on race, national origin, gender, age or disability. This applies to programs such as the Medicare Advantage and Medicare Part D plans.

Also under ACA, insurers will not be able to charge women more simply because of their gender, health status or history. This provision of health care reform, which will become effective in 2014, will end what many view as a predatory practice by insurance companies who charged women higher prices for insurance or denied coverage because women can get breast cancer, have cesarean sections or suffer from chronic conditions such as high blood pressure and diabetes. Women tend to suffer more from chronic conditions because they live longer. Before passage of health care reform, only 10 states considered the practice known as gender rating illegal.

Health care reform will make it easier for anyone with preexisting conditions to get insurance. In most instances, insurance companies will no longer be allowed to deny health coverage based on preexisting conditions. This benefit was extended to children under 19 in 2010, except those with "grandfathered health plans." It will be extended to all Americans in 2014. At that time, virtually no one obtaining new health insurance can be denied medical coverage because of a preexisting condition.

Other insurance changes that will affect many consumers include:

  • Insurance companies will no longer be able to place lifetime dollar limits on coverage. Starting in 2011, no limits can be placed on coverage below $750,000. In 2012, that cap increases to $1.25 million and to $2 million in 2013. By 2014, all caps will be gone, and there can be no limits on lifetime dollar limits on coverage.
  • Insurance companies will no longer be able to charge higher, out-of-network costs for emergency room visits. This recognizes the fact that when people need emergency rooms, they don't usually have a choice of where to go.

Some new regulations on the insurance industry also will affect consumers. The health care reform law increases oversight of insurance companies by the federal government and other authorities. Insurance companies will be required to tell consumers of rate and benefit changes in advance. For example, consumers must be informed when rates will be raised by an average of 10 percent, and the companies must justify that increase.

In addition, insurance companies will be required to spend 80 percent to 85 percent of premium dollars on improving health care quality and providing beneficiaries with health care. If insurance companies do not meet these goals because their administrative costs or profits are too high, they must provide rebates to consumers.

To find out more, you may want to read:

Major Changes With Health Care Reform

More Options for Purchasing Insurance
A Perspective on Women and Health Care
Preventive Services Covered Under the Affordable Care Act

Timeline for Health Care Reform Changes
Health Care Reform: Where to Learn More
Ask the Expert: How does the new health care reform act affect older women?
Ask the Expert: How do the new health reform laws affect low-income women?

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