Affordable Care Act Stands: Implications for Providers and Medical Billing Companies

Yesterday morning the Supreme Court ruled in a 5-4 decision that the Affordable Care Act will stand. Now that the fate of Healthcare Reform has become more defined, we can take a look at the practical implications for healthcare providers and medical billing services. IN the NPR article “Health Care Law Upheld: Now What?”  the following key provisions are explained by Mary Agnes Carter of Kaiser Health News.


– Insurance carriers cannot cancel a subscriber’s insurance when the subscriber gets sick.

– Youth can be covered on a parent’s insurance plan until their 26th birthday.

– Children with pre-existing conditions cannot be denied coverage.

– Insurance carriers cannot place a “lifetime maximum” limitation on benefits.

– Insurance policies effective Sept. 23, 2010 and onward must cover certain preventive services without any patient liability (copays, deductibles, and coinsurance).

– Medicare’s preventive service coverage has expanded to include a larger number of screenings and the Annual Wellness Exam.

– Certain pieces of private Medicare Advantage Plans have been cut as a cost-containing measure.

– If you are 65+, the law narrows the “doughnut hole” gap in Medicare Part D prescription drug plan benefit. By 2020, the “doughnut hole” will be entirely eliminated.

– Effective Aug. 1, 2012, employers must provide health insurance plans that offer birth control as part of their preventive services.

In 2014:

– Adults will also not be denied insurance coverage for pre-existing conditions.

– Most individuals will be required (by the “individual mandate” portion of the Act) to have health insurance in 2014, or face a fine. The fine is $95.00 for individuals (or up to 1 percent of income), and $2,085 for families (or 2.5% of household income). The fine amount will continue to grow in upcoming years.

– Individuals that don’t qualify for Medicaid but still cannot afford coverage may be eligible for government subsidies.

– Each state is required to establish an insurance marketplace (called an insurance exchange) where private insurance can be purchased.


The Supreme Court decided that while Congress has the authority to expand Medicaid, it cannot threaten to remove funding from the states if the states do not participate in the expansion. It will be up to each state to decide whether or not it will expand coverage to more people. If states do decide to expand coverage, people with an income percent at or below 133% of the federal poverty level would be eligible to receive coverage.