- About three-fourths of people who purchase through the insurance exchanges (those with incomes between 133% and 400% of poverty) will receive a federal subsidy to help pay for the coverage.
- By 2014 at the latest, insurers will be banned from “gender rating,” or charging women higher premiums than men for the same coverage, both for individual policies and for employer group plans with fewer than 100 employees. In most states, women with individual plans pay on the average some 48% higher premiums than men for the same health insurance coverage.
- Every new insurance policy is required to include the basic preventive health care package without any co-pays or deductibles. As recommended by the Institutes of Medicine, this includes pap smears, mammograms, birth control, STI/STD testing, well woman checkups, immunizations and other preventive care.
- Exclusions for pre-existing conditions were immediately eliminated for children in 2010, and will be eliminated in 2014 for adults. This will prevent the exclusion of coverage for women who have “pre-existing conditions” such as pregnancy, prior injuries caused by domestic violence, the second or subsequent Caesarian delivery, re-occurrence of breast cancer, etc. A temporary high risk insurance pool program is available to cover eligible adults with pre-existing conditions until 2014.
- Beginning January 1, 2014, individual and small employer plans must cover at a minimum a comprehensive package of “essential health benefits” including, for example, pre-natal and maternity care, prescription drug coverage, mental health care, and pediatric care (including oral and vision care). Currently 87 percent of individual health insurance plans exclude maternity coverage.
- Medicare guaranteed benefits are not reduced.
- Beginning in 2011, Medicare now covers the full cost of preventive care, including cancer screenings, annual physical examinations and immunizations.
- The Medicare prescription drug “Donut Hole” will be gradually eliminated, starting with a $250 payment to beneficiaries in 2010 and a 50% discount on Medicare Part D prescription drug costs. By 2020, payments by beneficiaries will be reduced to 25% of drug costs in the gap.
- Employers will not be allowed to provide inferior plans with less coverage to their lower-paid workers, who are more likely to be women and people of color.
