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How U.S. Health Care Reform Works


Changes to Existing Insurance Plans
President Obama speaks at a town hall on health care reform in Montana.
President Obama speaks at a town hall on health care reform in Montana.
Associated Press/Jae C. Hong

If you currently have insurance, you probably won't notice too many changes when the majority of reform measures take effect. If you have children under the age of 26, however, there is one big change that affects you: Individuals are now allowed to stay on their parents' insurance plans until they reach age 26, whereas earlier rules booted some adult children off the roster before they hit 20.

Whether or not you have children there are several measures aimed at reforming insurance company practices that will provide you with a greater degree of protection should you get sick. Insurers will be forced to do away with annual or lifetime limits on care, so that people who get sick don't hit some arbitrary limit quickly and are forced to pay out of pocket. Insurance companies are also banned from canceling your policy once you fall ill.

Additionally, the bill requires private insurers to avoid discriminatory practices toward people with pre-existing conditions. Insurance companies are required to provide coverage to children with pre-existing medical conditions in 2010; everyone else with a pre-existing condition will be covered in 2014. In the meantime, adults with medical conditions are eligible for a new insurance program that offers affordable premiums for "high risk" individuals that will be run by the government.

In 2014, these individuals with existing medical conditions will enter into insurance marketplaces, or exchanges, to comparison shop for coverage. The exchanges will be set up and governed by each individual state. Insurance companies will offer plans within the marketplace, so the goal is to provide a little competition to keep insurance companies honest and premiums low. Each insurance plan must include certain essential benefits, such as preventive care, though there will likely be more expensive plans with more benefits available as well. No matter the plan, the exchange is designed to provide a forum for consumers to see very quickly how much a plan will cost them without reading hundreds of pages of fine print. A public insurance option run by the government won't be included within this marketplace.

Ready to head to that marketplace? Not so fast, there -- only certain people are eligible.


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