Patient Bill of Rights - Consumer Protections under the Affordable Care Act

Patient’s Bill of Rights

The Affordable Healthcare Act (ACA) ushered in a new Bill of Rights for health care consumers. These rights, implemented within the regulations associated with the Affordable Care Act, provide a variety of consumer protections, all of which will be fully implemented by 2014. With the Bill of Rights, patients now:

  • Can Obtain Coverage for their Children with Pre-existing Conditions: Children under 19 cannot be denied medical coverage solely due to a pre-existing condition. In 2014, this will apply to Americans of all ages. This provision may make health insurance available to anywhere from 4 to 17 million children with conditions such as asthma or diabetes who, prior to the ACA, could be denied coverage.
  • Have a Guarantee on their Choice of Doctor: Consumers can select any available participating primary care provider within their plan’s network as their primary doctor.
  • Can Extend Coverage for Young Adult Children: Consumers under the age of 26 may be eligible to be covered under their parent’s health plan. Children under 26 can remain on a parent’s health insurance plan even if the child is married or living outside the parent’s home.
  • No Longer Face Lifetime Limits on Coverage: Lifetime dollar limits on essential benefits are banned for all new health insurance plans. AARP has estimated that 100 million Americans have health insurance with lifetime limits.
  • Be Protected Coverage Cancelations Due to Honest Mistakes on Insurance Forms: Insurance companies can no longer cancel coverage just because the consumer or employer made an honest mistake when filling out insurance forms.
  • May Review of Premium Increases Before They Are Implemented: Insurance companies that increase their premium by a significant amount must submit the increase for public review.
  • Have at least 80% of their Premiums Spent on Health Care Services: Insurance companies that provide group insurance must spend 80% of premium dollars primarily on health care instead of administration costs.
  • Do Not Have to Pay More for Emergency Treatment at Out-Of-Network Facilities: Consumers that seek emergency care at an out-of-network hospital are not required to pay higher copayment fees.
  • Have the Right to Appeal Coverage Decisions: If a payment for treatment or service is denied by the insurance company, consumers now have the right to file an appeal for a review of the denial.

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