Health Care Reform Implementation

On June 28, 2012, the U.S. Supreme Court ruled that the Patient Protection and Affordable Care Act (ACA) is constitutional, therefore upholding the current provisions within the law and proceeding with implementation. The following provisions will have a direct impact on brain tumor patients.

Current benefits:

• Until age 26, young brain tumor patients may stay on their parents’ health insurance plans.
• Health insurance companies cannot refuse to cover children that have a brain tumor.
• Health insurance companies are prohibited from limiting the dollar amount of health care services they will cover throughout a patient’s lifetime.
• Brain tumor patients covered by Medicare Part D will continue to have lower out of pocket prescription drug costs as the ACA phases out the prescription drug coverage gap, or the “doughnut hole”.

Additional benefits to be implemented in 2014:

• Health insurance companies will be prohibited from denying coverage to an adult brain tumor patient or survivor because they have a pre-existing condition.
• Health insurance companies will not be allowed to charge brain tumor patients more in premiums solely because of their health status.
• Coverage will be expanded to thousands more brain tumor patients through expanded Medicaid eligibility and income-based sliding-scale subsidies to help patients purchase private health insurance through exchanges (health insurance marketplaces), which will be required to cover a range of essential health benefits.
• There will be limits on the out-of-pocket costs patients have to pay to access health care services and treatments, including anti-cancer medications such as temozolomide (Temodar®).
• Brain tumor patients who enter approved clinical trials will have their routine medical costs (associated with the clinical trial) covered by health insurance.

Right now, a brain tumor diagnosis and treatment can bring significant health care-related challenges, including difficulty accessing coverage due to a pre-existing condition, financial hardship resulting from the need for extensive and expensive health care services, and barriers to participating in clinical trials. National Brain Tumor Society will work to ensure that the Affordable Care Act is implemented in a way, which reduces these burdens on brain tumor patients and their families. We encourage you to join us. Become a brain tumor advocate and together, we can improve health care and work toward a cure.

For more information on our health reform implementation efforts on behalf of the brain tumor community, please contact David Arons, Director of Public Policy, darons@braintumor.org or 617-393-2861.