Fraction of insurance plans cover all services to be required next year
WASHINGTON — Just 2 percent of health plans available to consumers in the private insurance market offer all the coverage that will become mandatory next year under the federal health-care law, a new analysis has found.
Only about one in 50 plans now comply with the main requirements of the Patient Protection and Affordable Care Act, according to HealthPocket, a Sunnyvale, Calif., technology firm that “compares and ranks” health plans.
Consumers and the federal government might end up paying the cost of the new requirements through higher premiums.
The analysis found that basic benefits, including doctor visits, emergency-room care, hospitalizations and lab tests, were standard offerings for nearly all the 11,000 plans in the study.
But only 1 in 4 offered pediatric care, and only 8 percent covered dental checkups for children. About one-third covered maternity and newborn care, and just over half covered services to deal with substance abuse.
Those and other coverage areas are considered “essential health benefits” under the health care law. All health insurance plans in the individual and small-business market must offer them beginning next year.
But “we couldn’t find a single plan that had every feature fully satisfied,” said Kev Coleman, the head of research and content at HealthPocket.
Unless a health plan is exempted from the health-care law’s requirements, “it will have to change to survive,” Coleman said. “Consumers will be entitled to more health benefits in 2014 than ever before, and this will require existing health plans to expand coverage or close and be replaced by entirely new plan designs.”
The law requires that health plans offered to individuals and small employers provide coverage in 10 categories — ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
Massachusetts health plans, on average, offered more than most plans around the country, the analysis showed.