Health insurers and regulators have developed health plans with required essential benefits with relative ease and without major coverage changes or significant cost increases, according to a study from The Urban Institute and the Robert Wood Johnson Foundation.
Under the Patient Protection and Affordable Care Act, insurers selling non-grandfathered individual and small-group health plans through the new health insurance exchanges must include 10 categories of essential health benefits while limiting consumers' out-of-pocket costs.
The concept of establishing a meaningful and affordable essential benefit has roused debate among policymakers, with critics citing potentially problematic tight time frames and possible cost increases for consumers. However, researchers found most insurance companies were able to meet deadlines and find practical approaches to satisfying the essential benefit mandate. The study examined implementation of the mandate in Alabama, Colorado, New Mexico, Oregon and Virginia.
Furthermore, consumers probably won't see dramatic changes to their coverage in those states, partly because of state benefit mandates that predate the PPACA. Still, there are long-term questions about how health plans will conform to state benchmark benefit packages, and other PPACA requirements such as coverage for habilitative services could prove challenging for insurers and regulators, according to the study.
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