What To Expect In First 6 Months Of Overhaul

As the Senate inches closer to passing its health overhaul bill, some are pointing out that many changes, including a requirement that most Americans get insurance, won't kick in until 2014.

If health overhaul legislation passes, the Medicare prescription drug doughnut hole will be shrinkin i i

hide captionIf health overhaul legislation passes, expect some things to shrink, and some things to expand.

If health overhaul legislation passes, the Medicare prescription drug doughnut hole will be shrinkin

If health overhaul legislation passes, expect some things to shrink, and some things to expand.


But a handful of new rules and benefits kick in much earlier — six months after enactment. Here's what you can expect sooner rather than later:

A Shrinking Medicare "Doughnut Hole"
Starting in 2010, the coverage gap for prescription drugs in seniors' drug plans would shrink by $500 a year. Starting in July, brand-name drugs would be discounted by 50 perceny for many seniors in the coverage gap.

New Rules On Insurance Coverage
Within six months of enactment, insurers would be required to:
— Cover preventive care and wellness benefits — which insurers wouldn't be permitted to count toward enrollees' deductibles.
— Cover children with preexisting conditions, including asthma and cancer.
— Let young adults stay on their parents' plans until age 26 — which is longer than the current rules in most states.

There's one big caveat: All of the above changes only apply to new health insurance plans.

What exactly is a "new plan?" Any health insurance plan that you or your employer buys after the six months following enactment. Renewal of existing plans doesn't count, but all plans would be subject to the new rules starting in 2014.

A New National High-Risk Pool
Currently offered in many states, these plans are meant to provide coverage for people who are uninsurable for medical reasons. Under the Senate bill, some uninsured Americans, as well as legal immigrants with preexisting conditions, would be able to buy coverage through the pools.

Limits On Limits
There's some changes to the kinds of limits insurers can apply to your policy. "Lifetime maximum benefits" — or how much they pay out for your care as long as you're a member — are nixed, effective six months after enactment.

At the same time, the secretary of Health and Human Services will determine acceptable annual limits on insurers' coverage.

In addition, insurers wouldn't be permitted to cancel, or rescind policies, unless there's evidence of fraud or willful distortion of your medical history, effective six months after the law is enacted. But again, these requirements apply only to new plans for the first few years.

Tax Credits For Small Businesses
Some small business would be eligible for tax credits for 35 percent of their health-insurance premiums, starting in 2010. Amanda Austin, director of federal public policy at the National Federation of Independent Business, estimates the credits will apply to slightly more than 12 percent of businesses. While saying NFIB "is thankful the coverage was improved," Austin points to a Congressional Budget Office report that found the credits won't help reduce the overall cost of premiums for small businesses.

Information For Consumers
Finally, the Senate bill provides help to states to set up new offices for appeals and complaints against health insurers. And it calls for the creation of a new Web site that will help "facilitate informed consumer choice of insurance options."

The most expensive — and most controversial — parts of the new law don't start for a few years. So patients with preexisting conditions will have to wait; low-income Americans don't get expanded Medicaid coverage just yet, and other big changes — like the doling out of billions of dollars in subsidies to people who need help buying insurance — are still to come.

Steadman is a reporter for Kaiser Health News, a nonprofit news service.



Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Support comes from: