Thursday 23 Oct 2014

Information and opinions presented here do not always represent the views of the American Heart Association.

Affordable Care Act promises patient protections for young family members

Published: 10:38 am CDT, October 23, 2013

Cardiovascular health begins at an early age, making the need for affordable health care critical for our country’s littlest citizens.  Since the Affordable Care Act became law, patient protections are providing families with help toward their children’s medical needs.  Here are some highlights:

Birth: Nine of every 1,000 babies will have some form of congenital heart defect and one in every 4,000 will have a stroke. Prior to the passage of the Affordable Care Act in 2010, insurance companies could deny coverage to these young survivors based on a pre-existing condition, charge higher premiums because of their health status and place lifetime or annual caps on their coverage. This has left many families with high out-of-pocket costs and forced them to make difficult decisions to pay their medical bills.      

But under the Affordable Care Act, insurance companies cannot deny coverage to children based on pre-existing conditions or place lifetime caps on their coverage.  Beginning Jan. 1, higher premiums based on health status also will be prohibited, along with annual dollar caps on coverage.  

Children and teens:  With millions of children currently uninsured, the new Health Insurance Marketplace provides a “one-stop-shop” for parents to learn about health insurance options and find a plan that works. Many families are eligible for tax credits to help make their premiums more affordable or enable them to obtain free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).  Open enrollment for the new Marketplace runs through March 31.   

Beginning Jan. 1, plans purchased through the Marketplace will cover a set of 10 “essential health benefits,” many of which are critical to help keep kids healthy. Among these essential benefits are hospitalization, emergency services, prescription drugs, preventative screenings and rehabilitative services, which are particularly important to pediatric stroke survivors. 

For families who already have coverage through an employer, it is important to note that many plans must cover 25 preventive services for children, with no copayments or cost-sharing for the consumer.  Additionally, in the event of a job change or loss, families now have the security of knowing they will be able to get affordable coverage for their children.     

Young Adulthood:  For many families, especially those with children with pre-existing conditions, accessing affordable health care coverage past age 18 has been a concern. Under the Affordable Care Act young adults can stay on their parents’ policy until age 26, ensuring their ability to receive the regular quality care throughout their college and early-career years. 

Furthermore, young adults now have the security of knowing that they will be able to use the Marketplace to find an affordable plan if their employer doesn’t. They cannot be denied coverage based on a pre-existing condition at any time.