The implications of eliminating essential health benefits: an update
- Collection:
- Health Policy and Services Research
- Author(s):
- Blumberg, Linda J., author Banthin, Jessica, author
- Contributor(s):
- Robert Wood Johnson Foundation, issuing body. Urban Institute, issuing body.
- Publication:
- Washington, DC : Urban Institute, November 2020
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Costs and Cost Analysis Health Care Costs Health Insurance Exchanges Insurance Benefits United States United States.
- Genre(s):
- Technical Report
- Abstract:
- The Affordable Care Act (ACA) requires private nongroup (also called individual market) insurers to cover 10 essential health benefits: ambulatory patient services; emergency services; hospitalization; pregnancy, maternity, and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services (including oral and vision care). The law includes these benefits to ensure enrollees have adequate coverage for medically necessary services. In addition, the law prohibits insurers from placing annual or lifetime dollar limits on coverage for these benefits. Before implementation of these rules on January 1, 2014, nongroup insurers typically limited benefits considerably to reduce their risks of enrolling people with disproportionately high medical needs. For example, nongrop policies commonly either excluded prescription drugs entirely or placed stringent limitations on coverage, excluded maternity care entirely or charged more than the average cost of a typical birth to include such coverage, and rarely covered any mental health and substance use disorder treatment. Here, we update earlier work that evaluated the effect of particular essential health benefit requirements on ACA-compliant nongroup insurance premiums and estimated the implications of removing them for people who use those services.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-DC license. (More information)
- Extent:
- 1 online resource (1 PDF file (5 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918266093606676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918266093606676