Will Obamacare’s 10 Essential Health Benefits Provide You Better Coverage?

December 11, 2012

You have heard the stories before, be it first hand, on the news or through the grapevine. Almost everyone has a tale about someone not having a procedure covered by their health insurance. Some of these stories are true, some are not and some are just an amalgamation of myth, science fiction and silliness.

The Patient Protection and Affordable Care Act hopes to snuff out these stories by outlining a list of 10 essential health benefits all insurance plans must cover starting on January 1, 2014, but will they make your coverage better?

Here are the 10 essential health benefits outlined by the PPACA:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care

Of these 10 benefits only one and half are not covered under most health insurance policies today. If you go back before the PPACA was signed into law in March of 2010, only two and half were not covered.

What’s Not Covered?

The main benefit that is not covered right now on individual and family policies is Maternity care. In Ohio, with some companies you can purchase a separate rider to add that coverage, other states don’t offer that option at all. The “half benefit” is oral and vision care for children. However, like maternity care, this coverage is also available to add at an additional cost. The other benefit that wasn’t covered prior to 2010 was preventative services. Some plans, like certain Health Savings Accounts (HSA) did include preventative services before it was mandated by law.

Why is That Important?

It’s important because you shouldn’t expect this list to magically give your health insurance superpowers it didn’t already have. As you can see there is nothing here that will dramatically change your coverage. Most of the “big ticket items” have always been covered.

I Take That Back

There are some “health insurance plans” that more closely resembled a late night infomercial scam, than actual insurance. For people who have fallen victim to those types of plans, the 10 essential benefits will increase their policy’s coverage 100 percent. However, if you took the time to find a trusted and respected agent, who only represents reputable and financially sound insurance companies, little will change for you.

Is Your Coverage Better?

The terms good, better and best are all relative when it comes to health insurance. The most important, and impactful provision people will see as a result of the PPACA is access. Right now it’s not easy to get health insurance if you are not in decent health. So for those that haven’t been able to get coverage, yes it will be better. For those who already have it, it’s possible that access and handful of added benefits will only drive up the cost on your current coverage. So, in an indirect way, you coverage will have gotten worse because you are paying more for it.

To answer the question simply, yes, if you are a young married couple looking to start a family. Mandatory maternity coverage is a big deal and will be invaluable to you. No, if you are a more experienced married couple, chances are you don’t need maternity coverage any longer and it will only drive the cost of your coverage up.

A Few Things to Remember

Health insurance pays according to the policy you agreed upon at the time of purchase. That’s it. If for whatever reasons a company tries to skip out on a check, there are people who can help make it right. The most important aspect of healthcare reform you or anyone else should be excited about, is the guaranteed access you have to it starting in 2014. The biggest question mark now, is if you will be able to afford it.

Do you think your coverage will be improved by these 10 essential health benefits?