When the Supreme Court recently upheld most elements of the Affordable Care Act (ACA), both political parties went to the airwaves touting their respective views about the ruling. But, as someone who has advocated for health-care consumers for more than 40 years, I was troubled by some of the myths that both sides put forth.

Important points you should know about…

Myth #1: Everyone will pay a new tax. In the Supreme Court’s ruling, the ACA requirement that everyone must have insurance or pay some money to the government was deemed legal because Congress has the right to impose a tax as a penalty for not buying a health policy. Some pundits made it sound like everyone will be forced to pay a new tax. Not so. In fact, anyone on Medicare, Medicaid or who already has health insurance will pay no tax for this insurance. If you cannot afford health insurance, you will not be taxed, but instead receive a government subsidy to help you buy a policy. Be aware: Less than 1% of the population, according to the US Department of Health and Human Services, is expected to be taxed—those who can afford insurance but refuse to buy.

Myth #2: The new law will regulate drug costs for Medicare beneficiaries. When the Medicare drug benefit was passed in 2003, it included what became known as the “donut hole.” Here’s how it works: After you and your insurer pay for the first $2,930 worth of drugs (the amount for 2012), you must pay the next $3,727 totally out of your own pocket. The ACA changes that by first requiring that manufacturers give people in the donut hole a 50% discount on brand-name drugs to help offset their out-of-pocket costs. And over the next seven years, the donut hole is being gradually eliminated, meaning your insurance will be paying most of the drug costs you previously were paying in full. My advice: Since the ACA does not regulate the price of drugs, which are bound to increase over time, ask your doctor whether you can be prescribed generics or older, but effective, brand-name drugs. This can save you a bundle in out-of-pocket costs when combined with the change in the law.

Myth #3: Preexisting conditions will be completely covered. The ACA guarantees that by 2014 no adult (children are already covered) can be turned down for a policy by an insurance company because of a preexisting condition, such as cancer, heart disease or lupus. Unfortunately, many people believe that this means insurers must pay for everything related to the preexisting condition. But that’s not true. Under the law, the insurer must pay only for what your specific policy covers. For example, many policies don’t cover expensive cancer drugs or allow only for a certain number of physical therapy visits. My advice: If you have a preexisting condition, talk to your doctor to find out the type of treatments you likely will need in the future, and shop around for a policy that gives you the most coverage for your money.

Source: Charles B. Inlander, a consumer advocate and health-care consultant based in Fogelsville, Pennsylvania. He was the founding president of the nonprofit People’s Medical Society, a consumer advocacy organization credited with key improvements in the quality of US health care in the 1980s and 1990s, and is the author of 20 books, including Take This Book to the Hospital With You: A Consumer Guide to Surviving Your Hospital Stay (St. Martin’s).

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