Health Care Reform

Impacting You

Learn about the requirements

Health Care Reform changes how people get health care, how they get health coverage, what it costs and who pays for it.

Health plans have wider coverage because of the Health Care Reform law. Some of the benefits:

  • Children with pre-existing conditions, such as asthma, cannot be denied coverage
  • Certain preventive care services are covered with no cost-sharing
  • No lifetime dollar limits on essential health benefits
  • Expanded dependent coverage. Young adults can now stay on their parent’s health plan until they are 26, even if they are:
    • Married
    • Not living with their parents
    • Attending school
    • Not financially dependent on their parents
    • Eligible to enroll in their employer’s plan

IMPACTING YOU

  • The Individual Mandate
    The American Health Care Act of 2017 (AHCA) eliminates the penalties charged to individuals and employers for not having or offering health insurance coverage, effective retroactively to December 2015. This was referred to as the Individual Mandate. Although there are no penalties for not having insurance for the entire year, Total Health Care strongly encourages all members to sign up for health insurance during the designated Open Enrollment time frame November 1, 2018 – December 15, 2018 or risk not being covered for 2019 unless you qualify for a Special Enrollment Period.

  • Guaranteed Coverage
    Health plans can no longer deny coverage or charge a higher premium to adults because of a pre-existing condition.

    The law stops health plans from limiting both annual and lifetime coverage limits for essential health benefits.

    Regardless of how sick you may get, your health plan cannot cancel your coverage or place a dollar limit on your essential health benefits.

  • Essential Health Benefits
    Every health plan is required to cover Ten Essential Health Benefits (EHBs), which include:

    1.  Ambulatory patient services  (Outpatient care you receive without being admitted to a hospital)

    2.  Emergency services  (Care for conditions that if not immediately treated could result in a serious disability or death)

    3.  Hospitalization (Care you receive as a patient in a hospital, such as surgery and tests administered during your stay)

    4.  Maternity and newborn care (Care women receive before and after their baby is born)

    5.  Prescription drugs (Drugs prescribed by a doctor to treat an acute illness)

    6.  Laboratory services (Tests administered to help a doctor diagnose a medical condition and monitor effectiveness of treatment)

    7.  Pediatric services, including oral and vision care

    8.  Preventive and wellness services and chronic disease management

    9.  Mental Health and substance use disorder services, including behavioral health treatment

    10.  Rehabilitative and habilitative services and devices

  • Expanded Medicaid Eligibility
    Michigan’s Medicaid expansion program Healthy Michigan Plan covers households who earn up to 133% of the federal poverty level. To learn more about the program go to www.michigan.gov/healthymiplan

  • Affordable Care Act & Taxes
    Affordable Care Act & Taxes
  • Claims Payment Policies
    Claims Payment Policies
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