One Immediate Benefit of Health Reform

As the Wise Free Medical and Dental Clinic begins yet again to serve those in need, the new health reform law will allow a few of the people who attend Wise for medical help to receive insurance they might have been denied because of some pre-existing condition.

The Affordable Care Act created a new program- the Pre-Existing Condition Insurance Plan – for people denied health insurance by private insurance companies because they have a pre-existing medical condition.  

Virginia is one of the states that has opted by default to be part of the federal insurance program, rather than set up a state plan. (I suppose if the state had, by some miracle, attempted to develop its own plan, Ken Cuccinelli would have sued his own administration.)

As of July 1, the plan is open to American citizens and legal immigrants who have been at least six months without health insurance because they were denied coverage. The plan isn’t great – and it’s fairly costly since it’s individual coverage – but it will keep tens of thousands of people from going bankrupt because of medical bills.

The plan covers primary and specialty medical care, hospital care, and prescription drugs.

Here are more details:

Monthly premiums range from $289 per month for persons under 35 to $616 for those older than 55. There also is a $2,500 annual deductible. After that, a doctor’s visit requires a $25 co-pay.  Prescriptions will be covered for 50% of the cost. after a nominal cost for the first two prescriptions. Hospital stays are covered for 80% of the bill.

The beauty of this plan for many uninsured Americans is that it enables them to plan financially for a possible medical catastrophe. Because out-of-pocket costs cannot be more than $5,950 per year,  the insured can set up a dedicated account for that amount.

Another benefit is that the creation of these plans ends the conundrum that some people have when they would like to change jobs but feel that they cannot, due to having a pre-existing medical condition and a fear that they will not be covered by some new insurance plan.