States' essential benefits include preventive, alternative care


Almost half of all states have decided which essential health benefits must be covered in health plans sold through their health insurance exchanges, and many of those benefits include care insurers rarely, if ever, have covered in the past.

Chiropractic care, acupuncture, weight-loss surgery and infertility treatments are among the preventive and alternative care that the 23 states and the District of Columbia have so far chosen to include in their essential benefits package, reported The New York Times.

For example, California, Maryland, New Mexico and Washington will require insurers cover acupuncture for treating pain, nausea and other ailments. And Alaska and Nevada are likely to follow suit. Insurers in New York and California will have to cover weight-loss surgery, and companies operating in Massachusetts will have to include infertility treatment in their plans, according to proposals the state have submitted to the U.S. Department of Health & Human Services.

The minimum requirements for plans sold through exchanges vary by states because HHS only prescribed 10 broad categories of benefits, allowing states to determine which specific elements are mandated, FierceHealthPayer previously reported.

Despite such leeway in selecting essential health benefits, states' packages have been similar overall; for example, every state will require insurers cover primary care visits and certain diagnostic tests like X-rays and blood work.

"To people who care about particular diseases or conditions or provider groups, these don't feel like the margins," Alan Weil, executive director of the National Academy for State Health Policy, told the Times. "But at the end of the day, the core benefits are very standardized, and the differences are at the periphery."

States have until Dec. 26 to submit their essential benefits package to HHS.

To learn more:
- read the New York Times article

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