Most individual plans missing reform's essential benefits


Most of the individual health plans that insurers sell don't meet reform law standards that go into effect next year, according to a study published in the journal Health Affairs.

The gap in coverage comes from essential health benefits, including maternity care, and mental health and substance abuse services, that insurers must provide starting next year.

The new individual plans "will offer a lot more financial protection," lead author Jon Gabel told CNN Money. "Combined with a ban on medical underwriting, the individual insurance market in a post-health reform world will sharply contrast with the market of past decades," the study states.

Although some existing plans can be grandfathered in, the qualifying criteria, including having members enrolled in the plan since 2010 and maintaining steady co-pays, deductibles and coverage rates, is difficult to meet. That's why most insurers will scrap their individual plans that don't meet the new standards.

The Blue Cross Blue Shield Association, for example, is already preparing a whole new lineup of individual policies for 2014. Most Blue Cross individual plans "are going by the wayside," Kim Holland, BCBSA's executive director of state affairs, told CNN Money. "Plans will have to conform to the higher level of benefits."

But America's Health Insurance Plans worries the essential benefits will translate to individual plans that provide more coverage and costs than most individual customers want. And that may lead some consumers to choose to pay the fine of not obtaining health insurance instead of purchasing a policy.

"Now, people can choose the plan that best meets their needs," AHIP spokesperson Robert Zirkelbach said. Next year, "they may choose not to buy any coverage."

To learn more:
- here's the Health Affairs study
- read the CNN Money article

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