Federal Health Care Reform Brings Changes to MCPS Plan

There has been a lot of posturing over the impact of the new federal health care legislation. The immediate changes are beginning to take shape, and it is good news for health care consumers.

Take the MCPS insurance plan for example. As a result of the federal health care legislation passed this spring, there will be a number of significant changes to the MCPS plan, effective January 1, 2011. The same is true for almost all Americans with health insurance. Within MCPS the changes include:

* expansion of coverage to overage dependents
* elimination of co-pays on preventative health care
* lowering of out-of-pocket expenses for mental health care
* elimination of lifetime caps on coverage

Overage Dependents - Young adults up to age 26 will now be eligible to remain on their parents MCPS family insurance plan - for medical and prescription drug coverage. The usual MCPS open enrollment season (when you can make any plan changes) is scheduled for October 11 - November 12. If you have overaged dependents who you wish to enroll back onto your plan, you will be able to do so during the open enrollment period, for coverage effective 1/1/11.

Preventive Health Care - In order to increase access to preventive care, the new federal health care legislation requires the elimination of co-pays on a wide range of preventive services when they are provided by in-network providers. (Co-pays for out-of-network providers remain unchanged). MCPS has already posted a list of the preventive services that will now be provided without copayments.

Mental Health Care - Plans - like MCPS' - will no longer be able to charge higher co-pays for mental health visits than they do for other medical office visits. Under the current MCPS plans, many employees have to pay 50% of the charges for mental health care visits. As of January 1st, co-pays for visits to in-network mental health providers will be limited to $10 per visit in the Point-of-Service plans and $5 per visit in the HMOs. The co-pays for out-of-network providers, under the Point-of-Service plans will improve as well. After satisfying your deductible, such charges will be treated under the same 80%/20% split as other out-of-network medical office visits.

Lifetime Maximum Coverage - Though most folks don't realize it, the current MCPS health plan - like most plans - puts a limit on the maximum amount of coverage you can receive through the plan in your lifetime. The MCPS cap has been $2 million. Just last week there was interesting news coverage of individuals with chronic illnesses requiring very expensive, ongoing treatments, who faced having to change jobs in order to maintain health insurance coverage and not 'max-out' under their employer's plan. Effective 1/1/11, federal law prohibits such lifetime caps, so the cap in  MCPS will be eliminated as well. No one ever forsees needing that kind of ongoing, expensive health care. But it is reassuring to know that you wont' risk 'maxing-out' your health coverage if you or a family member face such a situation.

More details on the plan changes will be provided in the MCPS Open Enrollment materials that will be available in the next couple of weeks.

At a  time when most Americans are suffering financially, it is a welcome sign of hope that health insurance protection for everyone is improving in concrete, measurable ways.