“Essential Health Benefits” and a Birthday!

The Patient Protection & Affordable Care Act (ACA) is celebrating its fourth birthday today! Cupcake

Over the last four years, the ACA has made a number of changes to our health care system that have had an impact on the cancer community.

One of those changes was the new requirement that most health plans, whether they are offered inside or outside of the State Health Insurance Marketplaces, must cover “essential health benefits.”

Both small-group health plans that cover employers with less than 50 employees and non-grandfathered individual health plans are covered by the requirement.  Non-grandfathered health plans are plans that did not exist before March 23, 2010, when the ACA was signed into law.   In states where Medicaid is expanding, these programs must also offer coverage for essential health benefits to those who are newly eligible for Medicaid.

There are ten categories of essential health benefits that plans must cover:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventative and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

Along with coverage of essential health benefits, the ACA also allows people to get health insurance coverage regardless of their age, gender, or medical condition and prohibits insurance companies from charging people higher premiums because of their medical condition or health history.

If you do not have health insurance, or are losing your coverage this month, be sure to apply for health insurance through your State Health Insurance Marketplace before the deadline on March 31, 2014!

Get information on your State Marketplace, or visit www.HealthCare.gov to learn more about these health care benefits, as well as compare plans and find the one that fits your lifestyle and budget.

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