The recent health care plan put in place by the Obama Administration, The Affordable Care Act, puts into place strong consumer protections, provides new coverage options and gives you the tools you need to make informed choices about your health. General information about the plan is available from the government at, but it can be hard to sift through all the information to know exactly how this new plan will affect you. Those currently or previously involved in Workers’ Compensation instances should be aware of certain aspects of the new plan that will have a direct impact on some of the procedures and policies that may change when the new plan is fully adopted. We’ve highlighted a few main points from the new plan and expanded on how they will affect you.


One of the most important policies in the new health care plan is that it will provide coverage for pre-existing conditions. Many people experience denial of coverage due to a pre-existing condition that they, or their family member may have. This will change under the new plan. Previously, it was hard for families to find a plan that would take on what most insurance companies considered a burden. Under the new health care plan, coverage cannot be denied to those who have a pre-existing condition. These consumer protections were added to most plans when a new plan year or new policy year occurred on or after September 23, 2010 in the form of a temporary pre-existing condition plan. The important thing to note is that when 2014 rolls around, the pre-existing condition protection will be officially extended to all Americans. Keep in mind that it is acceptable to keep your health plan the same if you are satisfied- this is simply a process of ensuring that all Americans have the same health-care options.


The second important part of the new plan regards the ‘Donut Hole’ that is known to be part of Medicare Part D, which is the Medicare option of paying a monthly premium for outpatient prescription drug coverage. The “donut hole”, formally referred to as the coverage gap, has caused problems for people who are involved with Medicare Part D, but will soon change in the new health care plan. This gap occurs when you reach a certain dollar amount in your prescription costs, leaving the entire cost to fall on the individual while the insurance pays nothing. Those on Medicare typically pay 25% of the cost for their prescription drugs totaling under $2,800, and 5% of the cost for their drugs totaling over $4,550. The middle ground, $2,800-$4,550, is what defines the coverage gap and people are responsible for all costs in this range. When the new health care plan is adopted, the coverage gap will cease to exist and those who fall in (what was formerly) the gap will be eligible to receive certain discounts and coverage. This is an important step America is taking in the health care progression, but it will take until 2020 to reach that lowest percentage point that people will have to pay for their prescription drugs. By that year, you will be paying 25% for generic as well as brand name drugs in the former coverage gap- a huge improvement from the previous bill of 100%.


A third important aspect of the new health care plan involves preventative coverage. As certain conditions become more common and modern medicine advances to find relief for previously irreversible conditions, people are taking preventative measures so they don’t have to cope with a condition down the line. Allowing coverage for preventative measures is an opportunity for people to address problems before they may affect other areas of their lives. Common areas of health in which people seek preventative measures include family planning (birth control, contraception, testing), blood pressure and cholesterol screenings, osteoporosis testing and even colonoscopy procedures, just to name a few. The allowance of insurance companies to cover preventative measures is a step forward for people who have been trying to take care of themselves before health issues occur. This part of the new plan will help reduce costs in the future for Americans who are treating a condition that could have been prevented.


Though these facts are important for all Americans to know, they can have a substantial effect on those with Workers’ Compensation claims. Those who have been part of a Workers’ Compensation case may have moved past this part of their lives, but could still be suffering with the aftermath of an injury that stays with them even if they have gone back to work. The pre-existing condition section of the new plan will reassure any person who has a preexisting condition, including those caused by a work injury, that they cannot be denied benefits for that reason. Additionally, the cost of medication can be daunting. Some Americans are experiencing that the cost of medications needed to function after experiencing an injury on the job may fall in the coverage gap. It’s reassuring to know that under the new health care plan there will be some assistance when it comes time to pay for prescriptions. Being healthy before even setting foot on a job site may even help to avoid possible injuries. Having preventative measures included as part of your health care plan will enable you take preventative measures to avoid the possibility of a work injury.

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