The healthcare system in America is going through a process of massive reform which aims to restructure state-sponsored and non-government programs and offer competitive health insurance in the open-market. Achieving these goals mean bringing about changes in healthcare delivery, programs, administration and the responsibilities of providers, physicians and patients as well as Malpractice Insurance Reform.
Changes We Will See
Starting September 23, 2010, the first year of healthcare reform addresses some of the most widely prevalent coverage issues:
- Lifetime coverage limits have ceased to exist and annual limits are restricted.
- Insurance companies cannot cancel your coverage because you get sick.
- Insurance plans have to grant coverage to children with pre-existing conditions.
- Young adults up to age 26 ( and even higher in some states)can remain on their parents’ health insurance plan, married or not.
- Medicare prescription drug beneficiaries get a rebate to cover gaps in payment.
- Medicare enrollees will get free annual wellness visits and personalized prevention services.
- Small businesses get a tax credit to help provide coverage for workers.
- States will get assistance to expand the Children’s Health Insurance Program, establish treatment effectiveness and review health workforce needs.
- Community health centers will provide low-cost health care.
- Starting 2011, overpayments to insurance companies will be frozen and phased down in the years to come. Most of the payments that people make to insurance companies through Medicare Advantage will go towards their care rather than insurance company profits.
Starting 2012, models for healthcare litigation reform and to establish best practices will be set in motion. A national pilot program for Medicare will effect payment bundling so that doctors, hospitals and other care providers can better coordinate patient care. 2013 will see greater transparency in financial relationships among health entities like hospitals, physicians, pharmacists and providers of pharmaceuticals, devices, medical supplies.
In 2014, all American citizens and legal residents will be required to have insurance and to pay a fine if they do not. States will set up health insurance exchanges for small businesses and individuals, although more competitive plans will probably be more complete and affordable in the open-market. Companies with more than 200 workers will be required to have an employee health plan. Employers will get tax benefits for providing insurance. Businesses with 100 employees or fewer can offer them insurance through the state’s exchange or a health insurance pool or in the open-market.
Insurance Providers – Focus on Compliance
Insurance companies in the U.S. are focusing on achieving compliance with the new legislation. They are busy working on updating plans to meet the new requirements and to offer people the healthcare benefits that the state intends them to have. Insurance companies are doing their bit to educate their customers and healthcare providers in their network on the new scenario so that they can find the way forward.
