Report finds less than 2% of health plans meet ACA requirements

Following the Department of Health and Human Services’ releasing of their final rule on Essential Health Benefits required by the Affordable Care Act in 2014, an analysis from HealthPocket Inc. has shown that less than 2% of health care plans currently available meet the requirements set out by the Department of Health and Human Services.

“It’s important for consumers to understand that these coverage gaps currently exist in the plans available today. Just like preexisting condition exclusions allow health plans to avoid paying for certain risks, the coverage gaps we see in this report are another way that plans can currently elect to not cover certain health care costs,” Kev Coleman, head of research and data at HealthPocket, stated in a press release. “Coverage will become more complete starting in 2014, and the vast majority of plans in the market today will no longer be sold after the end of this year in their present form.”

HealthPocket analyzed 11,100 health insurance plans for individuals and families under the age of 65 years to compile this report. Some categories outlined in Essential Health Benefits are covered, such as emergency care, hospitalization services and ambulatory care, according to the report. However, 34% of plans covered maternity and newborn care, and 24% of plans covered pediatric dental and vision care, 61% covered mental health services and 54% covered substance use disorder services.

According to the report, coverage varied by state with Massachusetts covering 94% of Essential Health Benefits, followed by Rhode Island at 93%, Hawaii at 90%, and California and Maryland at 89%. Alaska had the lowest coverage rate at 66%, with Wisconsin (67%), Texas and New Hampshire (68%) and Louisiana (69%) having similar coverage rates.

Reference:

www.healthpocket.com