The Patient Protection and Affordable Care Act of 2010 was meant to expand health insurance coverage to millions of Americans who had previously not had access to insurance. The law also provides new insurance protections for children, who can be left vulnerable if their parents lose their health insurance because of unemployment or if the child has a pre-existing condition and isn’t covered on a parent’s plan.
As a patient advocate, you can help your clients navigate the new federal healthcare reform law and inform them about how the legislation impacts their children.
Here are the main changes in the law that patients should be aware of:
- Under the Affordable Care Act, health insurance plans cannot limit or deny benefits or deny coverage for a child younger than age 19 simply because the child has a "pre-existing condition” – that is, a health problem that developed before the child applied to join the plan.
- This ban includes both benefit limitations, such as an insurer or employer health plan refusing to pay for chemotherapy for a child with cancer because the child had the cancer before getting insurance, and outright coverage denials. Coverage denials happen when an insurer refuses to offer a policy to the family for the child because of the child’s pre-existing medical condition.
- Until now, health plans operating in the U.S. could refuse to accept anyone because of a pre-existing health condition, or they could limit benefits for that condition.
- The new rule applies to all job-related health coverage as well as individual health insurance policies.
The Affordable Care Act also laid down new provisions for low-income families with children and former foster care children
- Children whose parents make an annual income of up to 133 percent of the federal poverty level – about $45,000 for a family of four – are available for coverage under CHIP, the federal Children’s Health Insurance Program, a free or low-cost health plan. Nearly all states provide Medicaid and/or CHIP coverage to children up to 200 percent of the federal poverty level, with 25 states covering children at or above 250 percent of the federal poverty level.
- Under the healthcare reform law, states are not permitted to scale back these income eligibility levels and enrollment procedures that are already in place.
- Children up to age 26 who "age-out" of foster care will also be eligible to continue receiving Medicaid benefits.
- The new healthcare reform law also allows parents to keep their young adult children on their health insurance plans, if their plan covers children, until they turn 26 years old. Previously, health plans could drop enrolled children at age 19, although some plans allowed parents to keep older children on their plans if they were full-time students.
Adult children can join or remain on their parents’ health plan whether or not they are married, living with the plan-holder parent, financially dependent or in school. Young adult children can also remain on their parents’ plan even if they are eligible to enroll in their employer’s plan. Some group health plans can limit this option to adult children that don’t have another offer of employment-based coverage.