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

Miley Cyrus hospitalized, cancels Kansas concert, condition unknown,…

Singer Miley Cyrus was hospitalized on Tuesday night after suffering what is believed to be 'a severe allergic reaction' to antibiotics medication. The 21-year-old Bangerz…

News

Explosions in new Boston Marathon bomb panic, 'twisted'…

A fresh Boston Marathon terror alert, which caused Bomb Squad officers to order an evacuation while two controlled explosions were carried out, was today being…

Local

D.A. Williams opens new unit to focus exclusively…

D.A. Seth Williams announced Tuesday that he has opened a new unit focused entirely on investigating wrongful conviction claims.

Local

BSL, El to run all night on summer…

Officials announced this week that it would institute a pilot program this summer that would keep the El operational from 5 a.m. Friday morning until midnight Monday morning starting in…

Entertainment

Miley Cyrus hospitalized, cancels Kansas concert, condition unknown,…

Singer Miley Cyrus was hospitalized on Tuesday night after suffering what is believed to be 'a severe allergic reaction' to antibiotics medication. The 21-year-old Bangerz…

Television

'Orphan Black's' Jordan Gavaris talks Felix's Season 2…

Jordan Gavaris plays heroically helpful foster sibling Felix to main clone Sarah on "Orphan Black." We talked to him about what’s ahead for him in…

Going Out

Here's what to do in Philly this weekend

FILM 'Through a Lens Darkly'  Thursday, April 17, 6 p.m. Philadelphia Photo Arts Center 1400 N. American St. Free, RSVP required, 215-232-5678 www.philaphotoarts.org Join Philadelphia…

Arts

Peek behind the scenes at the Academy of…

Generations of visitors have marveled at the dioramas in the Academy of Natural Sciences, watching apprehensively at the puma perpetually poised to attack the unsuspecting…

U.S. Soccer

Andrew Wenger has big shoes to fill on…

Lancaster County native Andrew Wenger will feel pressure to fill the shoes of departer forward Jack McInerney.

NBA

NBA Power Rankings: Are the Spurs frauds? Could…

NBA Power Rankings: Are the Spurs frauds? Could the Mavericks surprise?

NBA

Sixers, Michael Carter-Williams give fans a happy ending…

The 2013-14 season for the 76ers has nearly come to a close.

NHL

Flyers must make Rangers feel their presence

Perhaps it’s the proximity of the two biggest cities in the East, because whenever these two square off the intensity seems to rise.

Home

Steal home decorating tips from Nattystyle blogger Natalie…

Despite the towering ceilings and enviable exposed brick, it’s easy to see how Natalie Decleve’s apartment could be considered a challenge. Perched above the streets…

Home

How to plant a garden in the city

Small on space but big on gardening? You can still have that welcoming oasis of fresh air with an urban garden. Peter Smith, owner of…

Style

Victoria's Secret Fashion Show moving to England

It will still broadcast on CBS this fall.

Tech

Google Glass finally goes on sale for regular…

The Google Glass finally went on sale for regular people. It only costs $1,500.