How Will the Patient Protection and Affordable Care Act (PPACA) Improve the Health and Health Care of Virgin Islanders This Year?

The new health care law includes elements to protect you – the health care consumer.  They include the following:

• Children Under the Age of 19 Cannot Be Turned Down by Insurance Plans, Even If They Are Already Sick. The new law prevents insurance companies from denying coverage to children under the age of 19 due to a pre-existing condition. Effective on or after September 23, 2010 for new plans and existing group plans.
• Extend Coverage for Young Adults.Under the new law, young adults will be allowed to stay on their parents’ plan until they turn 26 years old. Many insurance companies already started doing this. Check with your insurance company or employer to see if you qualify. Effective on or after September 23.
• Beginning to Close the Medicare Prescription Drug “Donut Hole”.  An estimated four million seniors will fall into the Medicare prescription drug “donut hole,” making it hard for them to afford their medicines. Each such senior will receive a $250 rebate. First checks mailed in June, 2010, and will continue to be mailed out monthly throughout 2010 as seniors fall into the donut hole.
• Providing Free Preventive Care.  Health plans must make certain preventive services, like mammograms and colonoscopies, are free of charge.  Effective on or after September 23, 2010.
• Helping Small Businesses Pay For Their Worker’s Health Care.   Small businesses can get help to provide insurance benefits to their workers. The first phase provides a credit up to 35 percent of what the business pays for their employees’ health insurance.  Small non-profit organizations may receive up to a 25 percent credit. Effective now.
• It Is Much Harder For Insurance Companies To Drop Coverage When You Need It (except in cases of fraud).  Before the new health care law, insurance companies could search for any mistake on a customer’s application and use that mistake as a reason to deny payment for services when he or she got sick. The new law makes this illegal. Effective on or after September 23, 2010.
• Protects Lower-Wage Employees From Being Treated Unfairly.  The new law makes it illegal for health insurance companies and their employees to treat higher-wage workers better than lower-wage workers.  Effective in 2010.
• No Lifetime Limits on Insurance Coverage. Under the new law, insurance companies cannot set lifetime dollar limits on basic health care benefits, like hospital stays.  Effective beginning on or after September 23, 2010.
• Makes It Harder for Companies to Put Yearly Limits on Coverage.  Under the new law, insurance companies’ use of annual dollar limits on the amount of insurance coverage a patient may receive will be restricted for new health insurance plans.  Effective on or after September 23, 2010.
• Helps Patients Fight Back Against Insurance Company Decisions.  The law provides consumers with a way to fight against dropped coverage decisions made by their insurance company, and establishes a fairer, external review process. Effective on or after September 23, 2010.

The new law will improve health care quality and lower health care costs by:

• Preventing Disease and Illness.  A new $15 billion Prevention and Public Health Fund will invest in different programs that will keep Virgin Islanders healthy.  Funding begins in 2010.
• Stopping Health Care Fraud. The new law creates different ways to reduce fraud in Medicaid, Medicare and CHIP.  Many provisions effective now.

Virgin Islanders can count on expanded access to affordable health care and skilled primary health care providers because under the new law, the following starts this year:  

• Make Sure That You Have a Doctor or Nurse When You Need One.  The new law has programs to increase the number of primary care doctors, nurses and physician assistants in areas that need them. Effective 2010.
• Cover More People – With Better Services – on Medicaid.  The new law includes much more funding for the Medicaid program in the U.S. Virgin Islands.  This will allow for more people to receive coverage and better care under Medicaid. Effective 2010.
• Strengthen Community Health Centers.  The new law will help build new community health centers and fix those that already exist in communities the U.S. Virgin Islands. Effective 2010.