The first wave of changes under national health reforms taking effect today include expanded coverage for the young and will result in modest cost increases, according to health insurers.
Expanded protections include the elimination of pre-existing conditions for children and allow young adults up to age 26 to remain on their parents' health insurance plan.
For seniors, the reforms will close the payment gap, often called the "doughnut hole," for prescriptions, as well as provide a free annual wellness visit.
Also, lifetime caps on health insurance coverage now have been eliminated under the Affordable Care Act, passed six months ago by the Democratic-controlled Congress over the opposition of Republicans.
"They're significant, but, overall, they're fairly minor compared to what's coming," Dan Ulmer, assistant vice president of government relations for Blue Cross Blue Shield of North Dakota, said Wednesday.
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The North Dakota Blues estimate that premiums will increase an average of 2 percent as a result of the new mandates taking effect today, although Ullmer said, "It could be more than that."
Across the Red River, Blue Cross Blue Shield of Minnesota estimates premiums will increase between 6 and 9 percent for most individuals, spokeswoman Pam Lux said.
"Our small group rates are relatively flat," she added.
The new law also expands Medicare access to preventive care and preventive services at community health centers.
Insurers said it is important for consumers to check their policies and visit with their agents for specifics.
"Most of our products had no or very little sharing of preventive costs anyway," Lux said. Similarly, the Minnesota Blues started allowing young adults up to age 26 to remain on their parents' plans and did not have lifetime coverage caps.
Sanford Health's plan also started allowing young adults up to age 26 to remain on their parents' coverage. North Dakota and South Dakota capped lifetime coverage at $2 million, a ceiling Sanford never encountered in its 14 years, said Ruth Krystopolski, president of the Sanford Health Plan.
As a large employer, Sanford Health also pays health insurance costs, she noted. Sanford Health estimated its insurance costs would increase less than 2 percent as a result of the changes taking effect today.
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"It actually was pretty marginal," Krystopolski said.
Meanwhile, health insurers, providers and employers are preparing for further reforms that will be phased in over the next several years, with many of the biggest changes taking effect in 2014.
Among the issues to be decided through regulations fleshing out the new law: a definition of essential benefits that health plans will be required to cover.
Some early indications suggest those essential benefits will resemble health plans for federal employees, which are more generous than many private plans, Krystopolski said.
If so, many private insurers including Sanford already offer plans to cover federal employees.
Health reform calls for so-called accountable care organizations, beginning as demonstration projects, that will strive to deliver health care more efficiently.
Integrated health systems like Sanford that combine a full spectrum of health services with insurance coverage are well positioned to be accountable care organizations, said Cindy Morrison, Sanford's vice president of public policy.
Health reforms expand coverage, including access for many who were uninsured, but face a challenge in restraining costs, she said.
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Health insurers are concerned that adequate incentives and penalties are in place for individuals - especially the young and healthy - to abide by mandates that will be required in 2014 to carry health insurance, Ullmer said.
Without adequate "sticks and carrots," insurers will be left with an older, sicker population, which would drive up costs, he said.
Readers can reach Forum reporter Patrick Springer at (701) 241-5522
