This year alone, about 795,000 Americans will have a stroke. The health impact for stroke survivors can be shattering, while the financial impact can add to the difficulties for people who don’t have health insurance.
About 14 percent of stroke survivors are uninsured and more than one-third have been forced to go without coverage at some point. The implications are significant from both medical and financial vantage points. Stroke patients without health insurance have a 24 to 56 percent higher risk of death than those with insurance. For those experiencing medical bankruptcy, stroke resulted in average out-of-pocket spending of more than $23,000 in 2007, the most recent year these statistics are available.
The good news is that the Affordable Care Act adds new protections and coverage options that will help stroke survivors. Here is a look at how the healthcare law may benefit stroke survivors and those at risk:
- Improving access to insurance: Health insurance companies can no longer deny coverage to people who’ve suffered a stroke or have other pre-existing medical conditions, nor can they charge higher premiums because of a medical condition. In addition, the new Health Insurance Marketplace is a single location where stroke survivors without insurance can shop for a health plan that meets their needs and budget.
For people with low or moderate income, financial assistance is available as a tax credit to help buy coverage through the Marketplace. Stroke survivors will be able to access affordable health insurance even if they are not able to work and are not eligible for Medicare. In some states, low-income stroke survivors may also qualify for free or low-cost coverage through Medicaid.
- Coverage for the care that stroke survivors need: Health plans sold to individuals and families must now meet minimum requirements to help ensure that the health care people need will be covered. For example, plans now must cover 10 categories of “essential health benefits” that includes the range of benefits that stroke survivors need, such as emergency care, hospitalization, doctors’ office visits, prescription drugs, laboratory tests, and rehabilitative and habilitative care and devices.
The law also prohibits insurers from imposing lifetime or annual dollar limits on essential benefits, although plans may still impose quantity limits on specific services. In addition, under the law, consumers’ annual out-of-pocket spending for their health care, including deductibles, co-insurance and co-payments, are capped at no more than $6,350 per individual or $12,700 per family in 2014. These limits will help protect stroke survivors and their families from catastrophic costs.
- Helping to prevent stroke: Of course, the best way to avoid consequences of stroke is to prevent it in the first place. There are currently many missed opportunities for stroke prevention, particularly in the area of high blood pressure, a major, controllable risk factor for stroke.
The law now requires Medicare and most private health plans, including all of those sold through the Marketplace, to cover a range of evidence-based preventive services at no additional cost to consumers.
Covered preventive services include screenings for high blood pressure, high cholesterol and diabetes, counseling for obesity and tobacco cessation services. In addition, the law makes an unprecedented investment in community-based prevention and provides “Transformation Grants” to communities around the country to help develop strategies to reduce the burden of stroke and other chronic diseases.
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