Despite reform, excluded benefits largely unchanged
Most of the healthcare services excluded in the pre-Affordable Care Act insurance market have remained excluded in the ACA era.
In fact, 80 percent of pre-healthcare reform coverage exclusions are still among the most frequently excluded by ACA plans, according to a new study from HealthPocket. The study found 10 services with exclusion rates of 59 percent or more:
|Excluded service under ACA in 2014||Plans excluding the benefit|
|Long-Term Care||99 percent|
|Cosmetic Surgery||92 percent|
|Adult Dental Services||89 percent|
|Weight Loss Program||88 percent|
|Routine Foot Care||72 percent|
|Infertility Treatment||67 percent|
|Private Nursing||67 percent|
|Adult Eye Exam||61 percent|
|Weight Loss Surgery||59 percent|
"The Affordable Care Act has had a profound influence on individual and small group health plans but our investigation found its effect upon the most frequently excluded medical services less significant," Kev Coleman, HealthPocket's head of research and data, said in a statement.
This year's list of most frequently excluded medical services doesn't feature children's dental coverage or eyeglasses, both of which made top 10 list in 2013, because reform requires insurers to include pediatric dental and vision coverage as essential health benefits. Last year, 92 percent of insurers didn't offer children's dental check-ups and 87 percent didn't include children's eyeglasses in their health plans, FierceHealthPayer previously reported.
Under the reform law, insurers must cover obesity preventive services with no out-of-pocket costs--but the services offered vary. The study highlighted the inconsistency in obesity-related benefits, as weight loss surgery and weight loss programs made the top 10 list of excluded services (not covered by 59 percent and 88 percent of insurers, respectively). The study also showed coverage discrepancies across states, noting 34 states and Washington, D.C, exclude routine foot care and only 24 states exclude routine adult eye exams.
With a lack of coverage conformity, insurers soon will get more details from the Obama administration on what they must include within plans sold on health insurance exchanges, FierceHealthPayer previously reported. Moreover, coverage exclusions have slipped hrough the cracks thanks to an ACA loophole that lets companies offer minimal coverage as long as they offer one plan complying with reform requirements.
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