Essential Health Benefits When States Decide
Health Insurance Print

AHCA Essential Health Benefits by State: Will it Affect My Health Insurance?

Last week we presented our independent analysis of how The American Health Care Act (AHCA) could impact those with pre-existing conditions. As promised, this week we take a deeper dive into how it would impact essential health benefits.

What Are Essential Health Benefits?

A list of medical services that private health insurance must cover for every customer.

The ACA set a minimum standard for private health insurance in all states to cover this list of 10 essential health benefits.

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn coverage
  5. Mental health and substance disorder coverage
  6. Prescription drugs
  7. Rehabilitation services
  8. Laboratory services
  9. Preventive and wellness services
  10. Pediatric services

What Does the AHCA Propose to do About Them?

The AHCA would allow individual states to apply for a waiver. This waiver would no longer require that private health insurance in that state include all 10 of these benefits in their policies. The reason some states are interested in doing this is to see if it helps cut the cost of health insurance premiums.

Essential Health Benefits by State

Keep in mind that before the Affordable Care Act (ACA), all 50 states had a combined total of 1900 laws that required private health insurance companies to cover a variety of health benefits.

There just wasn’t a set standard nationwide. So if your state applies for a waiver, its own laws about required health benefits are still in place unless those are changed.

However, maternity coverage and treatment for substance use disorder were the most common services that states did NOT require private health insurance to cover before the ACA was enacted.

Does this Affect My Health Insurance?

Yes, it Does:

  • If your employer provides health insurance using a private health insurance company (except for “grandfathered plans”)
  • If you buy individual health insurance

No, it Doesn’t: