physiciansCan I Keep My Insurance Coverage?

Many people with disabilities have questions about keeping their current insurance coverage after January 1, 2014.

After January 1, 2014 every citizen of the United States will be required to have health insurance. The frequently changing mandates and confusing instructions have left many people wondering if their current insurance coverage complies with the Health Care Reform Act. Mega Life and Health Insurance put together a comprehensive fact sheet explaining the rules concerning a person keeping their current coverage (https://www.megainsurance.com/healthcarereformfaq).

 

The first step is to determine if a policy is issued as an individual, small employer group or large employer. People receiving Supplemental Security Income (SSI) automatically receive Medicaid and people receiving Social Security Disability Insurance (SSDI) may be eligible for Medicare after two years of receiving SSDI benefits. This article will address individual policies for people who are not covered by employee plans and also not eligible for Medicare or Medicaid.

  YES NO
Individual Policy?    
Purchased before March 23, 2010?    
Policy has remained unchanged other than adding dependent(s) since March 23, 2010?    

If you answered "NO" to any of the questions then your policy probably does not have grandfathered status and will be required to be updated.

In general, if your policy was purchased prior to March 23, 2010 it can receive “grandfathered” status as long as the policy has not changed since March 23, 2010 in areas that affect the amount or percentage of cost-sharing for items like co-insurance, deductible or co-payment. In other words, if the amount of your co-pay or deductible has changed since March 23, 2010 then the policy cannot receive grandfathered status. Adding a spouse or child will not affect the grandfathered status.

Once a policy loses its grandfathered status the status cannot be regained. A person who is covered under a policy that cannot gain grandfather status will be affected by the new healthcare laws and will need to verify that their insurance complies or may be required to purchase a new policy. Some companies are simply re-issuing policies to reflect the changes, however some will be cancelling policies.

Individual health policies that are grandfathered are still required to change in the scope of what is covered, so the cost may increase as companies make these changes. Some changes include the removal of lifetime limits on most benefits, ability to add or keep children on the policy through age 25, and companies may not cancel the policy unless the applicant falsified information when applying for the policy.

In comparison, new policies are required to be more comprehensive in coverage and are widely expected to be more expensive. New policies must include items such as 100% coverage for preventive services covering a range of health concerns. These items are not required to be covered under grandfathered plans that currently do not cover them.

As January 1, 2014 gets closer, it is expected that new mandates and rules will be passed down which may affect the basis of this article. It is recommended that you verify with your insurance company that your policy is approved so that you do not face fines for lack of or improper coverage.

 

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About the Cochran Firm Disability Lawyers

Recognized as one of the nation’s premier law firms, The Cochran Firm handles cases on behalf of clients seeking a Personal Injury Lawyer, Criminal Defense, Medical Malpractice, Bankruptcy Attorney in Atlanta or Social Security Disability Lawyer.The Firm can be reached at 1-800-THE-FIRM (1-800-843-3476) or fill out the form on this page. “Working for You.” Article by Benjamin A. Irwin, Esq.


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