2014 is coming.
And in 2014, the majority of provisions in the “Affordable Care Act” (ACA – often popularly referred to as “Obamacare”) take effect. The result will significantly impact nearly everyone because the law will require every American to purchase health insurance.
The law also mandates a series of “Essential Benefits” that each health insurance policy must cover. Some of these are probably included in your current plan, but several mark significant changes. While many of these changes are attractive, bear in mind that these new mandates are a big reason that the prices you encounter next year may well be significantly higher.)
Here are the 10 Essential Benefits that are mandated:
- Hospitalization. This one’s pretty self-explanatory. Your insurance will have to cover hospitals stays, including inpatient surgery and recovery. If you have a major medical insurance plan now, you almost certainly have this coverage, so there’s nothing really new here.
- Emergency services. Another obvious one! Visits to the ER, including ambulance services or treatment at an urgent care center must be covered. Again, there’s probably not much changing from your current plan (though you may have some limits or maximums on ambulance services).
- Prescription drugs. If your doctors prescribes drugs for you, the plan must cover them. Most traditional plans include this coverage, though many “value” plans do not (because of the significant cost involved in covering pharmaceutical drugs – this is a big driver of price in your healthcare!).
- Laboratory services. This includes blood tests, X-rays, MRIs, and stuff like that.
- Maternity and newborn care. Here’s a big change. In many states (including South Carolina and Georgia) there are simply no health insurance policies available on the individual market that cover maternity / pregnancy. That changes in 2014 as charges related to pregnancy, prenatal care, complications, delivery, etc. must be covered. While that’s nice, it’s worth noting that this is also one of the changes that will impact the price you pay.
- Pediatric services, including oral and vision care. Here’s another significant change. For children, dentist check-ups, routine eye doctor visits, eyeglasses, immunizations, and that sort of thing must all be covered. Again… this cuts both ways. It’s nice to have these coverages, but it will impact the premiums families pay.
- Preventive and wellness services, including chronic disease management. A lot of these mandates went into effect soon after the bill was passed. It includes screening for things like osteoporosis and mammograms, as well as helping those living with long-term conditions like diabetes.
- Mental health and substance use disorder services, including behavioral health. This is new ground for many individual health insurance policies, though some policies included some benefit in these areas. Now they’ll be covered. (And, again… it’s not free folks…)
- Rehabilitative and habilitative services and devices. Physical therapy, speech therapy, artificial limbs, and other medical equipment will be covered.
In other words, these plans will be quite comprehensive. Unfortunately, we expect that they will also be quite expensive, especially given limitations on deductibles and out-of-pocket maximums that were part of the health reform law. Many consumers will qualify for government subsidies to help foot the bill – if you make up to 4x the federal poverty limit you could get some help if you buy a plan on the government exchange (another topic for another time). Exactly how much of a subsidy you’ll get is an open question.
A big question.
It’s worth noting that many health insurance companies are allowing clients to keep their 2013 plans (and, more importantly, their 2013 premiums) until the end of 2014. If you’re interested in exploring that option (it will almost certainly save you some serious money), we invite you to contact us.
AC Forrest is committed to helping our clients figure out what to do and how to do it (long-time clients and those just getting on board because of these changes). Stay tuned!