Consumer protections under the ACA

The Affordable Care Act includes a long line of provisions that ensure consumers will be treated fairly in the marketplace

The health reform law did many other things besides mandate the creation of state health insurance exchanges – also known as health insurance marketplaces. There were some important consumer protections that will give people buying insurance a little more assurance they may be treated fairly in the marketplace.

The most important one, says Praeger, is guaranteed issue – as of 2014, insurance companies will have to sell you a health plan, they can’t say no. “To me that is the best part of health reform,” she says.

A related change in the ACA is community rating, which is a limitation on the variation of rates among different kinds of people. So insurance companies can’t charge an older woman many times more for a premium than a young man.

Another consumer-friendly initiative, launched in September 2011 by the Department of Health and Human Services, helps states fight huge premium hikes by insurance companies. “This is having an impact,” says Sandy Praeger, Kansas Insurance Commissioner and a strong supporter of reform.

The rate review program requires companies to justify their rate hikes and “companies are being more cautious knowing they have to defend an increase,” she says.

The Obama administration touts these as a “patient’s bill of rights,” drawn from the Affordable Care Act:

  • Protecting Your Choice of Doctors: Choose the primary care doctor you want from your plan’s network.
  • Keeping Young Adults Covered: If you are under 26, you may be eligible to be covered under your parent’s health plan.
  • Ending Lifetime Limits on Coverage: Lifetime limits on most benefits are banned for all new health insurance plans.
  • Ending Pre-Existing Condition Exclusions for Children: Health plans can no longer limit or deny benefits to children under 19 due to a pre-existing condition.
  • Ending Arbitrary Withdrawals of Insurance Coverage: Insurers can no longer cancel your coverage just because you made an honest mistake.
  • Reviewing Premium Increases: Insurance companies must now publicly justify any unreasonable rate hikes.
  • Helping You Get the Most from Your Premium Dollars: Your premium dollars must be spent primarily on health care – not administrative costs.
  • Restricting Annual Dollar Limits on Coverage: Annual limits on your health benefits will be phased out by 2014.
  • Removing Insurance Company Barriers to Emergency Services: You can seek emergency care at a hospital outside of your health plan’s network. Since the Patient’s Bill of Rights was enacted, the Affordable Care Act has provided additional rights and protections including:
  • Covering Preventive Care at No Cost to You: You may be eligible for recommended preventive health services. No copayment.
  • Guaranteeing Your Right to Appeal: You now have the right to ask that your plan reconsider its denial of payment.

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  • Guaranteed issue‘ means insurance companies will have to sell you a plan.
  • A rate review program requires carriers to justify their rate hikes.
  • The ACA ends denial of coverage due to pre-existing conditions.