Courtesy of Obamacare . . .
Beginning in January, 2014, if you have an individual or family health insurance policy issued (or modified) after March 23, 2010 your policy MUST conform to the new federal guidelines. This means adding at least 10 new benefits you may not have on your current plan and may not want.
Beginning in 2014, all non-grandfathered health insurance coverage in the individual and small group markets, Medicaid benchmark and benchmark-equivalent plans, andBasic Health Programs (if applicable) will be required to cover essential health benefits (EHB), which include items and services in 10 statutory benefit categories, such as hospitalization, prescription drugs, and maternity and newborn care, and are equal in scope to a typical employer health plan.
What are Essential Health Benefits?
Plan provisions the government says your health insurance policy must have, or else you are not in compliance and must pay a penalty.
Here is the abridged summary.
physician and specialist office visits, inpatient and outpatient surgery, hospitalization, organ transplants, emergency services, maternity care, inpatient and outpatient mental health and substance use disorder services, generic and brand prescription drugs, physical, occupational and speech therapy, durable medical equipment, prosthetics and orthotics, laboratory and imaging services, preventive care and nutritional counseling services for patients with diabetes, and well child and pediatric services such as immunizations.
You may be thinking, this doesn't sound too bad.
ALL health insurance policies issued or modified after 3/23/2010 must include benefits and pricing for maternity and pediatric services. All policies.
It doesn't matter if you are young, old, male, infertile. Your policy MUST have those benefits and you will pay for them whether you like it or not.
And how about those mental health services, including substance abuse?
Psychiatric services can be very expensive and many existing health insurance policies either do not cover treatment or limit you to maybe 20 visits per year.
Starting in 2014 ALL policies must cover mental health services as any other illness. Unlimited doctor visits. Unlimited inpatient treatment. All very expensive.
How much will all this cost?
Glad you asked.
In addition to offering EHB, these health plans will meet specific actuarial values (AVs): 60 percent for a bronze plan, 70 percent for a silver plan, 80 percent for a gold plan, and90 percent for a platinum plan. These AVs, called “metal levels,” will assist consumers in comparing and selecting health plans by allowing a potential enrollee to compare the relative payment generosity of available plans. Taken together, EHB and AV will significantly increase consumers’ ability to compare and make an informed choice about health plans.
Yes, the federal government is going to make it EASY for you to pick a plan . . . and they will make it affordable according to actuarial values for metal plans.
It will be just like going to a fast food restaurant. Give me a bronze plan and a gold plan to go.
Now that you know all this, go enjoy your Thanksgiving.