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Most Health Plans Don't Meet ACA "Essential Health Benefits" Criteria

03/12/13

  11:57:18 am, by MedBen5   , 230 words,  
Categories: News, Health Plan Management

Most Health Plans Don't Meet ACA "Essential Health Benefits" Criteria

Essential Health Benefits Coverage

Apparently, the Obama administration has set a pretty high bar for what constitutes “Essential Health Benefits". Technology company HealthPocket examined 11,000 individual health plans across the U.S. to determine how many of them met the Affordable Care Criteria criteria for standard coverage – and less than 2% passed.

Beginning in 2014, every qualified health plan must offer minimum categories of health insurance coverage under the rules of the health care reform law. But on average, the health plans provided just 76% of the ACA’s Essential Health Benefits (see chart).

Among the findings in the HealthPocket study:

  • All (or nearly all) or the health plans provided required benefits for hospitalization, emergency care, ambulatory care and preventative & wellness care.
  • Dental and vision care for children was the least likely of the Essential Health Benefits to be provided in base benefits for a health insurance plan – just 24% of health plans nationally had these benefits within their base coverage.
  • Only about one in three plans provided essential maternity benefits.

HealthPocket also speculated that the coverage expansion required by the ACA could cause health care premiums to rise in 2014, due to such factors as:

  • The closing of the coverage gap as described in the study.
  • Guarantee issue provisions that will allow people with pre-existing medical conditions to enroll in health plans.
  • ACA actuarial value requirements on the maximum out-of-pocket costs that can be charged to beneficiaries.

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