Essential Health Benefits: Additional Benefits = Higher Costs

Essential Health Benefits: TIME FOR AFFORDABILITY. ADDITIONAL BENEFITS = HIGHER COSTS Starting on January 1, 2014, the Affordable Care Act (ACA) requires that all health insurance policies sold in the individual market and to small employers cover a broad range of benefits, many of which are not included in some policies today. As a result, millions of people will be required to purchase health insurance that is more comprehensive and more expensive than they have now. Current Coverage Add Benefits Reduce Cost-Sharing Meet Minimum Actuarial Value Test Requirement of 10 Categories of Coverage Limits on Cost-Sharing Minimum Actuarial Value of 60% or More Maternity Care H Hospitalization 100% Rehabilitative & Habilitative Services Laboratory Services - Minimum A Pediatric Services Prescription Mental & Behavioral Health Treatment Ambulatory Patient Services 0% Individuals The health reform law limits Emergency Servičes Actuarial value is the Preventive & Wellness Services purchasing coverage on their own can choose a plan that patient cost-sharing: • No cost-sharing for preventive care services • No annual limits • No lifetime limits • Cap on out-of-pocket costs percentage of health care costs the plan will cover for an average beneficiary. There are ten categories of required benefits that have to be included in all policies-some of which are not included in policies today. best meets their needs and budget. Independent Estimates of Premium Impact" in Individual Market (Prior to Proposed Regulations) .13% 2.2% 3% 3.2% 6% 8% 8% 13% 20% 20% 33% ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ RHODE ISLAND COLORADO NEVADA ALASKA WISCONSIN OREGON MINNESOTA MARYLAND CONNECTICUT OHIO INDIANA MAINE * Prior to application of premium subsidies 1 According to the U.S. Department of Health and Human Services, many individuals and families purchasing coverage on their own do not currently have coverage for some of these services, such as maternity services (62 percent), substance abuse services (34 percent), mental health services (18 percent), and prescription drugs (nine percent). 2 Research Findings: Independent Studies Estimate the Cost and Coverage Impact of the Áffordable Care Act in Selected States, AHİP Design AHP-AI Rgra Rauret DAP 2012 AHIP Higher Premiums (Impact depends on current coverage)