By 2014, many familiar health insurance frustrations will come to an end with the implementation of mandatory, essential health insurance plan benefits. Despite the backlash President Obama faced after his proposal to require every American to obtain healthcare – regardless of the financial obstacles they might face in doing so – the 2010 Patient Protection and Affordable Care Act included a bulletin that would require certain insurance providers to include a set of essential health insurance plan benefits in their policies. With this new proposal, average Americans would get a lot more bang for their buck when it comes to their health insurance and will worry less about the harrowing costs of going to the doctor or hospital when they are in dire need of medical attention.
Thousands of Americans fail to get the proper medical care they need because they fear they cannot pay these astronomical costs, many of which were previously not covered by their insurance providers. Since this new regulation of providing essential health insurance plan benefits applies to both individual and group plans, as well as providers both listed and not listed as part of Affordable Insurance Exchanges (which help citizens find a health insurance provider that is right for them and their budget), all Americans who are enrolled in a health insurance plan will have access to these essential health insurance plan benefits by 2014 – even if their plan did not cover them before.
Which Benefits Categories Are Included?
The essential health insurance plan benefits package was proposed by the U.S. Department of Health and Human Services and it includes service coverage in the following 10 categories:
- Ambulatory Patient Services: these are basic outpatient services such as hospital or doctor’s visits, as well as outpatient surgery, as long as the patient is discharged the same day of the visit. Most insurance plans already cover this type of care.
- Emergency Services: this includes ER visits, emergency treatments, and ambulance fees. While it is rare for an insurance policy to exclude this service, many bare-bones plans may only include it on a limited basis or may not include it at all. Since emergency services have some of the highest costs, the inclusion of this service is vital to essential health insurance plan benefits.
- Hospitalization: this refers to inpatient services provided for a patient who is hospitalized for more than 24 hours or who requires long-term care for terminal illness.
- Maternity and Newborn Care: a must for young mothers who may otherwise be opposed to approaching a hospital for maternity services, and even the birth of the child, due to financial difficulty.
- Mental Health, Substance Abuse, and Behavioral Health Services: these are some of the newest to the pack, as most insurance providers are vague on whether they constitute “medical care”. With these essential health insurance plan benefits, therapy visits, AA meetings, counseling sessions, and more would likely all be covered by your health insurance provider.
- Prescription Drugs: under the new proposal, certain providers would be required to cover a percentage of all prescription drugs, whether generic or name-brand.
Rehabilitative Services: this includes physical therapy, speech therapy, occupational therapy, and other types of rehabilitation.
- Laboratory Services: whether you need basic blood tests or more specific tests to determine a diagnosis, your insurance plan will cover these, too.
- Preventive and Wellness Services: covering preventive services saves both the patient and the insurance company money. The more often you undergo preventive care, the less you will need to spend on medical care in the long run.
- Pediatric Services: all pediatric services will be covered, even dental and vision.
More about Essential Health Insurance Plan Benefits
The goal of this new benefits requirement is not only to make healthcare more comprehensive and affordable for all Americans regardless of income, but to also level the quality of healthcare across the board and make healthcare services for citizens similar to the premium healthcare services offered to federal employees. While all insurance providers will be required to include coverage of these services by 2014, it is worthwhile to note that some plans might even cover additional services as well, especially if they hope to become more competitive in this new healthcare market.