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
News

Mets mascot Mr. Met target of Bill Clinton…

Mets mascot Mr. Met has told how he ended up in the crosshairs of a Secret Service sniper rifle. The man behind the Mr. Met…

International

Jews in eastern Ukraine ordered to register, Kerry…

Secretary of State John Kerry condemned reports that Jews in eastern Ukraine had been ordered to register with the authorities "or suffer the consequences."

National

Chelsea Clinton pregnant with first child

Chelsea Clinton is pregnant with her first child.

National

Divers struggle in search for South Korean ferry…

By Jungmin Jang and Narae KimMOKPO/JINDO, South Korea (Reuters) - Rescuers struggled with strong waves and murky waters on Thursday as they searched for hundreds…

Movies

Review: 'Transcendence' is not stupid but sometimes lacks…

The cyberthriller "Transcendence" explores artificial intelligence, nanotechnology and other ethical quandaries, but has too much ambition, if anything.

Television

Dick Wolf to bring fictionalized world of 'Law…

A&E has ordered a pilot called "D.O.A." from "Law and Order" mastermind Dick Wolf that will focus on real detectives reexamining cold cases. A trio…

Television

Shane West talks WGN America's 'Salem'

The actor on history lessons, a new network and showing his butt.

Movies

Review: 'Fading Gigolo' finds few jokes in women…

John Turturro writes, directs and stars in "Fading Gigolo," in which he plays a prostitute whose pimp is Woody Allen. And there's still very few jokes.

NHL

Rangers draw first blood against Flyers in Game…

Brad Richards and Derek Stepan scored power-play goals 47 seconds apart to lead the Rangers to a 4-1 win.

NBA

Carmelo Anthony agonizing over Knicks future as season…

There’s still the cloud hanging over the franchise’s head as to the pending free-agent status of All-Star forward Carmelo Anthony.

NFL

Jets host players with eye toward NFL Draft

The Jets hosted a number of NFL Draft hopefuls for workouts on Thursday, with an eye toward some under-the-radar players.

NFL

Chris Johnson: I wanted to go to 'a…

Now that Chris Johnson is a Jet, the team has to figure out if one of the most explosive players in the NFL over the last half decade has anything…

Style

Light-up nail art syncs with phone

This Japanese technology syncs light-up nail art with your phone.

Wellbeing

Why is dance cardio taking off in NYC?

Instructors at some of the city's hottest classes explain why.

Travel

Earth Day travel in the Florida Keys

See why this eco-friendly destination deserves your attention.

Tech

Sorry, Facebook — FarmVille goes mobile with 'Country…

Zynga has released a version of the hit "FarmVille" tailored for smartphones and tablets in the hope of reaping a bumper crop of players.