The Affordable Care Act helps cancer patients and their families in many ways. Download this free document from the American Cancer Society The Affordable Care Act: How It Helps People With Cancer and Their Families to learn how to get the care you need as well as your rights and protections under the new law.
As a patient and a health care consumer it is important to understand your rights and your insurance benefits. For most people insurance and the new policies are very confusing. A cancer diagnosis is usually a financial stress for a family. Additionally dealing with the confusing insurance maze, understanding your coverage and real costs is all too common.
Most patients do not know that the Office of the Insurance Commissioner in your state provides free information and support about your rights. Additionally, if you feel an insurance company has not acted in good faith, you can file a complaint with your Insurance Commissioner and your case will be investigated. It is my experience that if your insurance adjuster knows that you are aware of your rights and that you plan to file a formal complaint with the Office of the Insurance Commissioner, you will usually get much better service from your insurer. Because most patients do not know their rights, insurance abuse is all too common. The Affordable Care Act is designed to remedy some, but not all, of these unethical insurance company practices such as denying care or delaying payment of claims.
Here are highlights from a free downloadable document available from the American Cancer Society The Affordable Care Act: How It Helps People With Cancer and Their Families
Providing quality care The new law allows more cancer patients and survivors to get the health care they need by:
- • Doing away with co-pays for proven preventive services in new plans and for those in Medicare
- • Requiring all health plans sold in new health benefit exchanges to cover essential benefits, such as coverage for cancer screening, treatment, and follow-up care
- • Making sure all people in Medicare get a yearly check-up to discuss disease prevention and other services they need to stay healthy
- • Focusing on treating pain and helping to improve a patient’s quality of life
- • Closing the Medicare “doughnut hole” so seniors don’t face a costly gap in prescription drug coverage
- • Making coverage available for patients who take part in clinical trials
Making health care more affordableThe new law makes health care more affordable by
- Ending limits on care and benefits. Insurance companies can no longer impose lifetime limits on benefits. Yearly limits are restricted and will end in 2014.
- • Ending limits on care and benefits. Insurance companies can no longer impose lifetime limits on benefits. Yearly limits are restricted and will end in 2014.
- • Ending higher charges for people who are sick. Health plans cannot charge people more for coverage based on their health status (starting in 2014).
- • Limiting the amount patients must pay in out-of- pocket costs and deductibles (starting in 2014)
- • Helping people and families with low to moderate incomes buy health insurance (starting in 2014)
- • Offering tax credits to small businesses that provide affordable coverage to their employees
Making health care more easily available The new law makes health care more easily available by:
- • Covering children. Insurance companies can no longer deny coverage for pre-existing conditions such as diabetes or cancer in children and, starting in 2014, in adults.
- • Ending rescissions. Insurance plans can no longer rescind, or stop, coverage because a patient gets sick.
- • Creating health benefit exchanges in every state. These exchanges will let people shop for insurance and compare health plans by quality and price.
- • Creating a health plan in every state to cover people with pre-existing conditions. These plans apply to people with cancer or another pre-existing condition who have not had insurance for 6 months or more.
- • Guaranteeing coverage. No one will be denied coverage because of his or her medical history, a guarantee that is backed by the requirement that all Americans buy insurance.
Making health care more simpleThe new law makes health care easier to administer and easier to understand by:
- • Making more information available. Insurance companies will be required to share more information about their plans.
- • Grouping health plans based on level of coverage. Plans offered in the health benefit exchanges
will be grouped based on their level of coverage – platinum, gold, silver, and bronze.
- • Setting standard rules. These rules will simplify the way consumers verify eligibility, check claims status, and make payments.
- • Giving patients new rights to appeal denied claims with their insurer
Myth and reality
Myth: The new law is government-run health care that takes away patient choice.
Reality: The law builds on the existing system
by requiring private health plans to make more information available to consumers, and strengthens it by fostering competition among insurance companies. This will help consumers make informed choices about the plan that is best for them.
Myth: The new law lowers the quality of care.
Reality: The law will make sure that all plans sold in the health benefit exchanges cover needed benefits and that consumers can compare plans by quality and price.
Myth: The new law increases costs to consumers.
Reality: The law will reduce consumer costs by:
- Doing away with out-of-pocket costs for preventive services
- Getting rid of yearly and lifetime coverage limits
- Encouraging more competition among plans
- Offering help to low- and middle-income people
Like most laws, the Affordable Care Act is complicated and can be hard to understand. Here’s more information that may help you. If you have questions, call your health plan, contact your state insurance commissioner, or call us at 1-800-227-2345. You can also visit the US Department of Health and Human Services Web site at www.healthcare.gov and Health Care and You, a consumer-friendly Web site created by leading health care groups, at www.healthcareandyou.org.