Updated April 24, 2010Besides offering several immediate health care benefits to all U.S. citizens, the new health care reform law will significantly affect persons with disabilities in several ways, both good and not so good.
Banning Pre-existing Condition Exclusions
Starting in September 2010, health insurance companies will no longer be allowed to refuse to cover children due to pre-existing medical conditions. The pre-existing condition ban will also apply to adults, but not until 2014 when the state-run health insurance exchanges are in operation.
In the interim, the law requires all states to create high-risk insurance pools to offer coverage to individuals with pre-existing medical conditions who have not had insurance for at least six months. While several states already have high-risk pools, the law requires all states to have them by June 2010. However, questions about how the high-risk pools will operate remain.
"The high-risk insurance pools may offer some people a safety net if they've exhausted their COBRA coverage or were denied private coverage because of a pre-existing condition. However, more detail on how the pools will operate, how to enroll and costs are needed before people can determine their true value; it's troubling that individuals will have to wait six months to be eligible," said Paul Gada director of Allsup Medicare Advisor, a Medicare plan selection service for people with disabilities and individuals over 65.
According to HealthReform.gov, high-risk pools generally charge significantly higher rates than they charge for a healthy individual in the individual insurance market. In addition, while they may insure people with pre-existing conditions, some high-risk pool companies will refuse to cover treatment for the pre-existing condition.
Help for SSDI Recipients?
Many disabled people rely on Social Security Disability Insurance (SSDI) benefits to help pay for health care coverage. While banning pre-existing conditions exclusions might help them, problems with the process remain. SSDI applicants often have to wait month, even years, for their claims for benefits to be approved or denied. As Mr. Gada points out, more than 7 million people who rely on SSDI benefits are eligible for Medicare - but only after a 24-month waiting period. "People with disabilities need continuous access to affordable healthcare coverage," said Gada. "They can't wait until they have SSDI income to finally pay for healthcare coverage or hold out the 24 months required before becoming eligible for Medicare."
Medicare and Medicare Advantage
According to Mr. Gada, people relying on Medicare may find fewer coverage options as a result of healthcare legislation. For 2011, the legislation freezes payments to Medicare Advantage plan providers at 2010 rates and further reduces payments over time to bring them in line with traditional Medicare.
Since Medicare Advantage covers most pre-existing conditions, it is often a better choice for people with disabilities. However, the reduced subsidies to providers under the health care reform law may reduce the number of insurers offering Medicare Advantage plans, and consumers may see premium increases or reductions in plan coverage benefits, according to Mr. Gada. "With the healthcare provisions, people with disabilities may be caught in a position where they're unable to afford a Medicare Advantage plan and unable to secure coverage under Medigap," he said.
Free Preventative Coverage Under Medicare
Starting in 2010, Medicare beneficiaries can make free preventive care visits to their healthcare providers, without any copayments or deductibles. People with disabilities may have frequent appointments with specialists; this provision helps ensure basic health needs are addressed.