A new report from health plan comparison website HealthPocket.com shows that fewer than 2 percent of all health plans sold on the individual market today provide all of the essential health benefits (EHBs) as required under health reform.
For the research, HealthPocket examined more than 11,000 individual health plans to determine coverage of each of the EHBs. The results showed that, on average, current health plans offer 76 percent of the EHBs required for all individual plans beginning Jan. 1, 2014. Benefits covered by virtually all the plans surveyed included hospitalization; emergency and urgent care; prevention, wellness and management of chronic diseases; ambulatory care; and lab tests.
Services offered by the fewest health plans centered on care for children or for coverage before or after childbirth. In all, only 24 percent offered the pediatric care, including vision and dental, spelled out in the ACA, and only 34 percent offered maternity and newborn care. Outpatient services for substance abuse issues such as alcohol and drug abuse were covered by only about half the plans.
[See also: Proposed regs on essential health benefits, pricing released by HHS]
On a state-by-state basis, Massachusetts' health plans had the most comprehensive sets of EHBs with the average plan in the state covering 94 percent, while Alaska's individual health plans had the lowest offering, on average only 66 percent of the EHBs. Texas, Louisiana, Wisconsin and New Hampshire were the only others states whose average health plans offered less than 70 percent of the essential health benefits.
While the study authors note that determining whether closing the EHB gap could cause premiums to rise is beyond the scope of this study, they did note the premium increases could result from any number of factors including:
- The closing of the coverage gap as described in this study
- Guaranteed 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