The nuts and bolts of the Affordable Care Act [The Porterville Recorder, Calif.]

Sept. 28--When President Obama signed the Affordable Care Act in March of 2010, the new law began a series of changes, including the beginning of cost-free preventive services for many Americans, and the creation of a new Patient's Bill of Rights that offers protection from insurance industry abuse. By 2011, Medicare Preventive Services went into effect, healthcare quality improved and its costs were lowered.

Under the law, health insurers must cover 10 essential benefits. The health plans will be more comprehensive -- and more costly. Starting next year, the rules will apply to all plans offered to individuals or through the small-group market to employers with 50 or fewer workers. The essential-benefits requirement does not apply to plans offered by larger employers, which typically already offer most of the benefits.

According to the Covered California website, key features of the benefits of the Affordable Care Act for Americans include free preventive care, prescription discounts for seniors, protection against health care fraud, small business tax credits, protection from pre-existing conditions, consumer assistance, and access to healthcare through a health insurance marketplace.

Already, the Affordable Care Act has benefited the nearly 85 percent of Americans who already have insurance, including:

-- 3.1 million young adults who gained coverage through the parents' plans.

-- 6.6 million seniors paying less for prescription drugs.

-- 105 million Americans paying less for preventative care and no longer facing lifetime coverage limits.

-- 13.1 million Americans receiving rebates from insurance companies.

-- 17 million children with pre-existing conditions who are no longer denied coverage or charged extra for medical care.

What Affordable Care Act covers:

According to the Covered California website, the covered benefits are ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative services and devices; laboratory services; management of chronic diseases, and preventive and wellness services; and pediatric services, including dental and vision care for children, aged 18 and younger.

People will be able to pick from insurance plans with differing levels of coverage and varying costs for co-pays and premiums. But insurers will have to cover a certain percentage of the services' cost.

"Most of the important services people need are covered, though there may be a slight variation [from state to state]," says Jennifer Tolbert, director of state health reform for the Kaiser Family Foundation.

-- Dental-Vision -- The new law does not mandate teeth-cleaning and eye exams for adults as it is not considered essential for adults -- making people responsible for paying for the service even after the Affordable Care Act takes full effect next year. Some states can still choose to have them covered but California is not one of them.

For children aged 18 and younger, whose parents or guardians get insurance through the individual or small-group plans, dental and vision is considered an essential benefit. Still, depending on where people live, getting coverage for children and teenagers might be complicated, as states can choose to offer those items as stand-alone plans, and federal subsidies would not help pay for the costs.

-- Pre-existing conditions -- Starting in 2014, most plans -- whether obtained through an employer or on the marketplace -- cannot deny coverage or charge more money because of a pre-existing health conditions.

However, if a person has what is known as a grandfathered individual plan -- a plan bought by the individual before March 23, 2010 and has remained unchanged -- the rule would not apply. It is important to check the details of an existing plan and consider shopping around if that is the case.

-- Out-of-pocket spending and lifetime limits -- Under the law, the amount of money people will have to pay out-of-pocket each year for medical and prescription drug costs will be capped at $6,350 for individuals and $12,700 for a family. These limits are separate from the monthly premiums people pay. The limits take effect in 2014 for those buying insurance on the state health insurance exchanges. For those with employer-based coverage, the restrictions will be fully in place in 2015. In addition, most insurance plans will be prohibited from setting lifetime cost limits on coverage for essential health benefits. This means your insurer cannot deny you coverage because your medical bills have gone over a certain amount.

-- AGE 26 -- One popular provision of the health care law is allowing young people to stay on their parents' insurance plans until age 26. This also covers dependents, including step-children, adopted children and some foster children. This benefit will be required of all plans that provide dependent care. Starting in 2014, younger people can remain on a parent's or caregiver's plan even if they have an employer option of their own.

Contact Esther Avila at 784-5000, Ext. 1045. Follow her on Twitter @Avila_recorder. The Associated Press contributed to this report.

Timeline of Health Insurance Marketplace.

October -- Open enrollment begins.

January -- Coverage begins.

March -- Open enrollment closes.

Future -- All Americans have access to affordable health care.

Also on January 1:

-- Health insurance plans cannot refuse to cover a person or charge more due to a pre-existing health condition, such as diabetes or asthma.

-- More people will qualify for Medicaid.

-- Insurance companies will no longer be allowed to impose annual dollar limits on coverage for essential health benefits.

-- Being a woman will no longer be a pre-existing condition, and insurance companies cannot charge women more than men for the same coverage.

--The small business tax credit expands.

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