Series Part 4: Affordable Care Act Facts

• Editors note: This is the fourth of a four-part series on health care, following a Monday, Aug. 20, forum at Pheasant Run in St. Charles.

According to Kenneth Munson, regional director of the U.S. Department of Health and Human Services, the Affordable Care Act requires:

• Insurers to cover children up to age 26 on parents’ health care coverage.
• The 80/20 rule, effective Aug. 1: For every premium dollar paid, 80 cents must be spent on care. While many companies already meet this threshold, Munson said about $1.1 billion will go back to consumers, either via direct rebate or discounts on future rates.
• Companies cannot deny coverage for children with pre-existing conditions. This would expand to adults in 2014. He said 75 percent of health care costs go toward paying for chronic conditions, which is especially important for women. The pre-existing condition list has been expanded for women.
• Bars lifetime limits on health care coverage. An end to annual limits would be phased in over the coming years.
• The Affordable Care Act bans recissions, which occur when an insurer cancels the coverage of someone diagnosed with a serious illness due to an honest mistake in the original health coverage application.
• Co-payments would be eliminated for certain diagnostic costs for preventative services. Munson said the reason is that the costs of co-payments has become an obstacle for those who should be receiving mammograms, colonoscopies and similar tests that can detect a problem early, before treatment becomes more expensive.
• Phases out by 2020 the so-called doughnut hole for Medicare beneficiaries.
• Fraud prevention is among the goals of the Affordable Care Act.
• Exchanges: Give people buying insurance the ability to compare apples with apples — in other words, compare plans where the coverage does not vary. Munson said this is a contentious issue at the state level now, because if the states do not establish exchanges, the federal government will do so..
• MedicAid expansion: Eligibility increases to 133 percent of the federal poverty level.

Related:

• Part 1: 
• Part 2: 
• Part 3: Health Care at a Glance
• Part 4: