The Implications of Eliminating Essential Health Benefits: An Update

Brief

The Implications of Eliminating Essential Health Benefits: An Update

Abstract

The Affordable Care Act requires private nongroup insurers to cover 10 essential health benefits in each plan they offer. The law requires these benefits be provided to ensure that enrollees have adequate coverage for medically necessary services. Plus, the law prohibits insurers from placing annual or lifetime limits on this array of required benefits. Prior to the implementation of the requirements in 2014, it was very common for nongroup policies to exclude benefits such as prescription drugs, maternity care, mental health and substance use disorder treatment, or to place significant limits on these and other benefits. Some lament that the ACA's benefit requirements increase the cost of private nongroup health insurance policies, preferring that the requirements be lifted or that states be permitted to waive them. In this analysis, we update previous work and estimate the shares of a typical nongroup insurance premium attributable to an array of different benefits. We also estimate the financial implications for people using those benefits should they be eliminated from the nongroup insurance benefit package.

Research Area: 

Centers

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