AMERICAN NURSES ASSOCIATION HIGHLIGHTS HOW HEALTH CARE LAW BENEFITS CONSUMERS
Starting January 1, 2011, more provisions of the new health care law will go into effect. The American Nurses Association has
been a staunch supporter of health care reform. ANA affirms that this law greatly increases access to care for millions of
people, and believes it will strengthen and improve the health care system for generations to come. The law also includes
provisions that will help transform our nation’s health care system from one that focuses on ‘sick’ care to one focused on
prevention, primary care and disease management. ANA encourages nurses to explain these benefits to their patients in order
for them to access both insurance coverage and health care services. The benefits in the law will help consumers optimize
their health and protect their financial security.
Benefits Now in Effect for Consumers
1. People can not lose their insurance coverage when they get sick; insurance companies are prohibited from dropping
coverage.
2. Individuals with pre-existing health problems will be able to access insurance. Children with pre-existing conditions
cannot be denied coverage by insurance companies. Adults with pre-existing conditions can enroll in the Pre-existing
Insurance Plan.
3. Consumers will not be at risk of losing benefits due to costly treatments; lifetime caps on insurance coverage are
banned, annual caps on coverage are restricted.
4. Children up to age 26 can be covered on their parents’ insurance plans.
5. Consumers will not have to share the costs for preventive services. Individuals who join new plans will have greater
access to preventive care services such as breast cancer screenings, immunizations and colonoscopies; “copays” for
these services will be eliminated.
6. For the first time since the Medicare program was created in 1965, Medicare will cover an annual wellness visit with a
participating doctor, also at no cost. This will allow beneficiaries enrolled in Medicare for more than 12 months to
meet with their doctors once a year to develop and update a personalized prevention plan as their needs change over
time.
7. Women may receive obstetric or gynecological care from any provider and insurance companies will treat their
authorizations the same as a primary care provider’s; primary care providers include doctors, nurse practitioners and
certified nurse midwives.
8. Consumers will have greater access to emergency services; insurers must provide covered emergency services
regardless of whether the provider is in-network.
9. Patients will have a greater choice of primary care providers including nurse practitioners and certified nurse midwives.
New plans will allow patients the choice of any primary care provider available.
10. Consumers will have stronger rights to appeal insurers’ decisions they feel are unfair or discriminatory.
11. Most people with Medicare will be able to receive free preventive services, including flu shots, cancer screenings and
diabetes testing.
12. Seniors who reach the coverage gap will receive a 50 percent discount when buying brand-name prescription drugs
covered by Medicare Part D. Over the next ten years, seniors will receive additional savings on brand-name and
generic drugs until the coverage gap is closed in 2020.
13. Many doctors and other health care professionals who provide primary care to people with Medicare will get a 10
percent bonus. This will help ensure that primary care providers can continue to be there for Medicare patients.
14. The new law generally requires that at least 85% of all premium dollars collected by insurance companies for large
employer plans are spent on health care services and health care quality improvement. For plans sold to individuals
and small employers, at least 80% of the premium must be spent on services and quality improvement. If insurance
companies do not meet these goals because their administrative costs or profits are too high, they must provide rebates
to consumers.