Only 2% of insurers cover mandated essential health benefits


Very few insurers--only 2 percent--offer all the benefits they will be required to provide next year under the reform law, according to a new analysis from technology company HealthPocket.

Based on an analysis of 11,100 private health insurance plans available for individuals and families, HealthPocket determined insurers will need to to bridge a "significant gap" between now and January to ensure they're providing all the reform law's mandated essential health benefits.

The U.S. Department of Health & Human Services outlined the specific essential health benefits insurers must cover in the file rule issued last month.

"Coverage will become more complete starting in 2014, and the vast majority of plans in the market today will no longer be sold after the end of this year in their present form," Kev Coleman, head of research and data at HealthPocket, said last week in a statement.

Particularly missing from health plans' benefits are coverage for maternity and newborn care, pediatric dental and vision care, mental health services and substance abuse services, the analysis found. But insurers already offer doctor visits, emergency room care, hospitalizations and lab tests as standard benefits.

"We couldn't find a single plan that had every feature fully satisfied," so insurers will "have to change to survive," Coleman told McClatchy Newspapers. "Consumers will be entitled to more health benefits in 2014 than ever before, and this will require existing health plans to expand coverage or close and be replaced by entirely new plan designs."

HealthPocket also analyzed coverage based on state, with Massachusetts health plans providing 94 percent of the reform rule's essential benefits. Rhode Island insurers covered 93 percent, Hawaii plans covered 90 percent and California, Maryland and Vermont insurers each provided 89 percent of benefits.

To learn more:
- here's the HealthPocket statement
- read the McClatchy Newspapers article

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