Ignore the insurance drama and get acclimated to your new plan

MIAMI, FL - SEPTEMBER 17:  Health and Human Services Secretary Kathleen Sebelius participates in a conference to discuss the U.S. Health and Human Services Secretary Kathleen Sebelius has had to defend the Affordable Care Act since its debut. Credit: Joe Raedle/Getty Images
U.S. Health and Human Services Secretary Kathleen Sebelius has had to defend the Affordable Care Act since its debut.
Credit: Joe Raedle/Getty Images

 Every week, Archelle Georgiou, MD, strategic adviser at Healthgrades, will explain one facet of the Affordable Care Act.

In response to the uproar about millions of individuals receiving coverage cancellation letters, last Thursday, the Obama administration announced that health insurance companies could extend those policies for one more year. Unfortunately, the conversation is centered on finding fault and where to assign blame. Is it the President for saying you can keep your plan or the insurance companies who sent out the letters?

Frankly, it’s neither. The reason for the letters being sent to approximately 10 million Americans is rooted in the Affordable Care Act’s (ACA) requirement that health insurance policies include coverage for:

1. Inpatient, outpatient and emergency care
2. Prescription drugs
3. Prevention and wellness services
4. Rehabilitative services and devices that help people with injuries or disabilities gain or recover mental and physical skills
5. Laboratory services including blood tests and radiology services

According to the Department of Health and Human Services (HHS), the vast majority of health insurance policies already cover these services. However, the ACA also requires the following “Essential Benefits”:

6. Maternity and newborn care for a mother and baby before and after the baby is born
7. Pediatric services, including oral and vision care for children
8. Mental health and substance use disorder services including counseling and chemical dependency services

HHS data shows that substance abuse services have only been covered by about 66 percent of plans and maternity and newborn care by 38 percent of policies. In addition, while routine medical care has been covered for children, according to a study by HealthPocket, comprehensive pediatric services, which include vision and dental care, have only been covered in 24 percent of policies.

In order to be compliant with the ACA, insurance companies had a choice: either amend the existing policies to include these additional services or cancel the policies and suggest that people buy one that includes all the required benefit. Either way, the added cost of maternity, mental health and pediatric care adds approximately 8-11 percent to monthly premium costs.

What if you don’t have children and have no need for pediatric care? What if you are 50, done having children and don’t want maternity care? The ACA doesn’t allow individuals to pick and choose from the list of Essential Benefits.

So, what should you do? My recommendation is to ignore the finger pointing. Instead, spend your time getting familiar with all the services covered by your new ACA compliant health plan — especially the preventive care and wellness services that you can get without copayments and deductibles.



News
Entertainment
Sports
Lifestyle
National

Mutant worms stay sober, even on alcohol

U.S. researchers have developed "mutant worms" that do not get drunk by alcohol, a breakthrough that could lead to new treatment for people trying to quit drinking

Local

K-9 nose helps capture $150K in cocaine at…

A furry, four-legged security agent helped authorities stop an illegal cocaine shipment from sneaking past JFK customs.

National

Minnesota man asked to leave Southwest flight after…

A man and his two sons were asked to leave a Southwest Airlines flight after the man sent a tweet complaining about being treated rudely by a gate agent.

National

Man sues hospital after surprise penis amputation

An Alabama man who went in to a hospital last month for a circumcision awoke after surgery to find his penis had been amputated, his lawyer said on Thursday.

Movies

Review: Brett Ratner's big 'Hercules' movie is small…

The latest "Hercules," starring Dwayne Johnson as the half-god beefcake of Greek myth, strips its hero and tale of most of its fantastical elements.

Arts

Scientists recreate world's smallest Monet copy

Scientists have reproduced a famous Impressionist painting using nano-printing, to create what has been described as the world's smallest work of art. Reworked at the…

Television

Jerry Seinfeld is ambidextrous, and other Reddit AMA…

See some of the weirder highlights of Jerry Seinfeld's recent Reddit AMA.

Going Out

Grab a pedestrian and start dancing at What…

As a New Yorker, I’ve mastered the art of focusing my gaze straight ahead. Though it occasionally piques my interest, the absurdities that play out…

NFL

2014 NFL Fantasy Football Top 100 overall player…

2014 NFL Fantasy Football Top 100 overall player rankings

U.S. Soccer

NYCFC announce signing of Frank Lampard

The tease of a big signing Thursday by new MLS side NYCFC ended up being one rumored for weeks. England midfielder Frank Lampard agreed to…

NBA

NBA great LeBron James sends 800 cupcake apologies…

By Kim PalmerCLEVELAND (Reuters) - NBA star LeBron James, whose recent return to the Cleveland Cavaliers in his home state of Ohio sparked a frenzy…

NFL

Jerry Reese confident with Giants, skipping countdown clocks…

Last year, Giants GM Jerry Reese installed a countdown clock in the locker room to inspire Big Blue to play in their own stadium for Super Bowl XLVIII.

Tech

Forget Wi-Fi: Li-Fi could be the future

Li-Fi technology – developed by Mexican company Sisoft – is wireless internet connectivity using specialized LED light.

Tech

Weather app Climendo might be the most accurate…

The wait for a truly accurate weather forecast could finally be over thanks to a nifty new app called Climendo.

Tech

Napkin Table puts focus off the phone and…

Michael Jan, a design student at Tunghai University in Taiwan, has invented a serviette-picnic blanket hybrid called the Napkin Table.

Style

Essie's new Color Boutique

Essie launches high-tech kiosks at major airports and malls across the country.