Pediatricians spell out how Affordable Care Act affects kids

WASHINGTON, Aug. 28 (UPI) -- The American Academy of Pediatrics spells out how the Affordable Care Act affects U.S. children in each state whether currently insured or not, officials say.

The AAP at its website, www.aap.org/en-us/advocacy-and-policy/Pages/State-Health-Insurance.aspx, outlines the benefits and protections already available under the Affordable Care Act that include:

-- Children age 26 and younger can be covered by a parent's health insurance policy.

-- Children age 19 and younger cannot be denied coverage because of a pre-existing condition such as a congenital abnormality.

-- Families can choose a pediatrician as a child's primary care doctor.

-- New private health plans must cover the cost of preventive care such as immunizations.

-- Out-of-pocket costs are capped at $5,950/per individual/year and $11,900/per family/year.

-- Health insurance companies can no longer set lifetime dollar limits on health benefits.

-- Insurance companies can no longer drop people if they get sick.

Having health insurance is now a requirement and as of Jan. 1, 2014, almost all Americans will be required to have health insurance or pay a penalty.

Consumers need to know that on Jan. 1:

-- If you have access to affordable insurance through your employer: you do not need to change insurance coverage if you don't want to.

-- If you do not have access to affordable coverage: You can get health insurance through your state's marketplace. Enrollment for new coverage begins Oct. 1, 2013. The marketplace is a new way to get health insurance for you and your family.

-- You can buy insurance directly from an insurance company or through a broker, or you can sign up through your new state marketplace. Through the marketplace, you can also find out if you qualify for Medicaid or the Children's Health Insurance Program.

-- Through the marketplace, you can find out what the cost of health insurance will be for you and your family.

-- Your application in the health insurance marketplace will tell you if you are eligible for financial assistance to help you buy private insurance. The amount of assistance depends on your family's yearly income. You may also have no cost if you qualify for Medicaid or CHIP.

-- The marketplace offers four different levels of health insurance plans. Those least expensive -- bronze -- have fewer benefits and higher out-of-pocket costs. Platinum is the most expensive and has more benefits and lower out-of-pocket costs. Each family or individual can choose the plan that best suits their needs.

Families, especially those who have children with special healthcare needs, can make sure the plan they purchase includes:

-- Their current pediatrician.

-- Access to pediatric specialists and pediatric surgical specialists.

-- Preventive care, such as well-child check-ups and immunizations.

-- Habilitative services to help a child keep, learn, or improve functioning.

-- Rehabilitative services such as physical or speech therapy.

-- Vision and dental care.

The Kaiser Family Foundation provides federal subsidy estimates under the Affordable Care Act for families and individuals at: http://kff.org/interactive/subsidy-calculator/.

Fox example, a family of four, two adults and two children under age 18, with an annual household income of $42,000, who do not smoke would have an unsubsidized annual family health insurance premium of $9,869 and qualify for a federal tax credit $7,641 -- 77 percent of the family premium -- and pay $2,228 per year for health insurance if their employers did not provide health insurance.