Individual and Family
Will Loosened Regulations of Health Benefits Help You Get Covered?
Published on June 18, 2018
Even though millions of Americans have gotten health benefits through the Affordable Care Act (ACA) Marketplace since it’s been around, the way Obamacare works still generates plenty of contention among consumers, public officials, and insurance companies. Many people who don’t qualify for large subsidies say that they can’t find good plans with affordable premiums in their area.
Certainly, the people who developed any legislation called the Affordable Care Act may have intended the new laws to support reasonably priced health insurance premiums. At the same time, lawmakers also wanted to make sure people purchased comprehensive health benefits, and it turns out, this costs a lot. Lawmakers understood that, and built in subsidies for insurance companies so they wouldn’t have to charge high premiums; however, the subsidies were reduced in 2015 and discontinued in 2017.
What are the ten essential health benefits?
Today, all qualified health insurance plans must offer the 10 essential health benefits, which have been part of health-care regulations since the ACA came into law.
So how could loosening the regulations make it possible for you to get covered? By allowing health insurance companies to offer plans with just the benefits certain people want, they might be able to make these plans more affordable. That way, people who couldn’t afford fully-loaded qualified plans can still get coverage.
What was the purpose of the 10 essential health benefits?
Before Obamacare, some consumers complained that they only realized their health insurance did not cover certain medical services after they made a claim. Even though the government did not standardize ACA plans the way that they standardized Medicare Supplement plans, they did require each health insurance plan to include certain coverage that they deemed vital.
Recently, people have been wondering if this law forces people to purchase health benefits they don’t need or at least, don’t want to pay for. For instance, an Obamacare plan has to cover both maternity and heart disease.
- Faced with rising premiums, a middle-aged man might wonder why he needs to pay for maternity care or birth control.
- On the other hand, young women who might need maternity care or birth control might also enjoy a much lower risk of developing heart disease, a medical condition more common with middle-aged men.
- It’s not possible for consumers to predict exactly what kind of health claims they or their family might make in the future, so there is no regulation of plans that is going to please everyone.
How would insurance companies prefer to approach health benefits today?
Recently, eHealth approached insurance companies for their preferred solutions to expensive premiums. Almost 70 percent of large for-profit and nonprofit insurers replied that laws should change to introduce more flexibility. If consumers had more choices about the health benefits they wanted to buy, most insurance companies said that they could lower premiums and encourage more participation in the Marketplace.
At the same time, a CNN report found that people have concerns that benefits like maternity care may become scarce or even more expensive if insurers don’t have to give them to everybody. Before the ACA, very few insurers offered maternity coverage for individual and family policies. According to Sherry Glied, a former Obama official and current dean at NYU, such conventional health care benefits as inpatient and emergency care actually generate the most costs.
Blue Cross Blue Shield backed up this statement with a 2016 study that found that offering health insurance to people with pre-existing conditions, who tend to use more expensive health care benefits, drove most of the premium increases. The ACA was also designed to make sure people with pre-existing health issues could buy insurance.
Expanding short-term health plans
Over half of the insurance companies in the eHealth survey also favored increasing the current 90-day limit for short-term health insurance plans. They believed this change to the ACA could encourage more people to buy some coverage, even if short-term health insurance doesn’t offer all of the essential health benefits.
In the survey, 67% of insurance company respondents said they thought that increasing this limit might also encourage more enrollment in temporary policies at the expense of ACA enrollments. While longer terms for temporary policies may increase overall coverage, it might also reduce enrollment in qualified plans.
Will loosened regulation of health benefits will make coverage easier to get?
There’s no saying. Obviously, insurance companies, the public, and the government don’t agree about the best solutions to the difficult problem of reducing health insurance premiums, and making sure everyone has the ability to afford coverage.
At the same time, you may have more choices about the way you get your health care benefits than you think you do. You can visit eHealth to request rapid, online quotes for many different kinds of ACA and non-ACA health insurance plans. Having lots of health-care options at your fingertips may give you the best chance to find affordable, high-quality health insurance plans.
While there has been discussion about loosening the regulation over essential health benefits, this article is only meant for general education, and may not be updated after publication.