This is the fourth in a series of blog posts celebrating the benefits that the Affordable Care Act (ACA) provides to people with disabilities. For the full list of prior and upcoming blog posts, see Friday’s news item.
The ACA Requires Every Plan Cover 10 Essential Health Benefits
In yesterday’s blog post, we highlighted the important protection that the ACA provides in prohibiting insurance companies from medically underwriting individuals, meaning charging them more if they have a disability or other underlying condition. For the same reasons that the prohibition against individual underwriting is needed, the ten Essential Health Benefits (EHBs) are needed to make sure that insurance companies are not allowed to charge more just because you require a certain prescription medication, mental health treatment, durable medical equipment, etc.
The 10 EHBs are as follows:
- Ambulatory patient services (i.e. outpatient 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
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Prior to the ACA, insurance companies would routinely decide not to cover certain of these areas or require people to purchase additional riders on their plan to cover these critical services. For instance, requiring people to purchase separate coverage for prescription drugs was not uncommon. Without the ACA’s 10 EHBs, it’s not too hard to imagine an insurance company trying to get around the prohibition against medical underwriting by simply providing a base plan with a very limited benefits package and then requiring enrollees to purchase additional riders for all the areas above. In essence, this would allow them to medically underwrite the individuals by having them pay for each service they needed.
The ACA’s requirement that all insurance plans cover the 10 EHBs is necessary to make sure that everyone has the comprehensive coverage they may need and that no one can be priced out of the market simply because they have special health care needs.
