On Jan. 1, 2014, President Obama’s Affordable Care Act greatly expanded the health care benefits being offered to the 55 million Americans with no health coverage, as well as millions more who are underinsured.
The law sets certain standards that all insurers must meet, and mandates that all health plans offered to those who buy health insurance on their own or in small groups include a set of “essential health benefits.”
Prior to the law’s passage, we saw “a race to the bottom, with insurers cutting benefits to lower premiums,” says Shana Alex Lavarreda, Ph.D., director of health insurance studies for the UCLA Center for Health Policy Research. “The essential health benefits set a standard for insurance. Anything below that is not true health insurance.”
These changes are welcome news to people ages 50 to 64 — especially the 9 million uninsured in that group, as well as the 4 million who buy health insurance on their own. A new study by HealthPocket, an independent research firm, found that less than 2 percent of existing individual health plans provide all 10 essential benefits. On average, today’s plans offer 76 percent of the benefits.
Read on to learn exactly what the essential benefits are, and see what you’ll be able to purchase once the new health insurance marketplaces open on Oct. 1.
1. Ambulatory Patient Services
This is the most common form of health care, often called outpatient care. You walk into a doctor’s office, get treated and then walk out. Nearly all health insurance plans already provide this coverage. Details about the plans’ networks and access to doctors will vary, but the law says the networks’ size must be “sufficient.”
2. Prescription Drugs
Many plans offer drug coverage only as an option at extra cost. But under the law, all individual and small-group plans will cover at least one drug in every category and class in the U.S. Pharmacopeia, the official publication of approved medications in this country. Drug costs will also be counted toward out-of-pocket caps on medical expenses.