Before the Patient Protection and Affordable Care Act (ACA) required all health insurance providers to cover delivery and inpatient maternity care, inpatient and outpatient substance abuse disorder services, and inpatient and outpatient mental health services as essential health benefits (EHBs), many plans in the non-group insurance market did not cover these services at all. An analysis from the Kaiser Family Foundation (KFF) highlighted the changes the ACA (P.L. 111-148) made, and questioned whether the gains in these coverage areas would be terminated by states if the American Health Care Act (H.R. 1628) is passed.
KFF analyzed data submitted by insurers for display on HealthCare.gov for the last quarter of 2013 because it is the most current year prior to when the ACA’s major insurance market changes went into effect, provides more benefit categories than some earlier years, and has more information about benefit limits for each category. The data included 8,343 unique plans across 50 states and the District of Columbia. All plans covered basic benefits such as inpatient hospital services, inpatient physician and surgical services, emergency room services, and imaging services, and 99 percent of plans covered outpatient physician/surgical services, primary care visits, home health care services, and inpatient and outpatient rehabilitation services.
However, other benefits were not covered as often. For example, 38 percent of plans did not provide coverage for inpatient or outpatient mental/behavioral health care services, and 45 percent did not cover inpatient or outpatient substance abuse disorder services. The least covered benefit was delivery and inpatient maternity care, which was not available on 75 percent of plans. Drug coverage also varied, with many plans not offering coverage of generic drugs (6 percent), preferred brand drugs (11 percent), non-preferred brand drugs (17 percent), or specialty drugs (13 percent).
Companies: Kaiser Family Foundation
IndustryNews: NewsStory AccessNews ContraceptionCoverageNews EssentialBenefitNews MaternalServicesNews
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