The Affordable Care Act requires that health insurance plans offered in the individual and small group markets, both in and out of the Marketplaces, offer a comprehensive package services known as essential health benefits. It also requires that these essential health benefits do not discriminate based on age, disability or expected length of life. Starting in 2014, all health plans must eliminate annual dollar limits on essential health benefits. Also, all health plans issued on or after September 23, 2010 must eliminate lifetime dollar limits on essential health benefits.

There are 10 categories of essential health benefits. They are as follows:

1.     Ambulatory Patient services, such as doctor’s visits

2.     Hospitalization

  1. Mental Health and Substance Use Disorder Services, Including behavioral treatment
  2. Rehabilitative and Habilitative  Services and Devices
  3. Laboratory Services
  4. Emergency Services
  5. Maternity and newborn care
  6. Prescription drugs
  7. Preventative and wellness services and chronic disease management
  8. Pediatric Services, including oral care, offered as part of a qualified health plan package or as a stand-alone plan.

Essentially, as a result of the Affordable Care Act, you will no longer be able to only buy the coverage you want. You will be forced to buy certain benefits, whether you need them or not. For example, you won’t be allowed to purchase a plan that excludes maternity coverage or you won’t be able to purchase only hospitalization coverage like you can now.

The only exception would be if your plan is eligible to be grandfathered in. In order for your plan to be grandfathered in, your health policy must have been purchased before March 23, 2010. Also, you or your carrier must not have changed the coinsurance or significantly increased the co-pays (more than $5 or 15% plus inflation) for your plan to be eligible. If you do decide to keep your grandfathered plan, you will not be eligible for the government subsidy.


Michael Acosta








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