What are the “10 essential health benefits” under the new AFFORDABLE CARE ACT?
President Obama’s health care act goes into effect on January 1, 2014, whereby over 50 million Americans without health coverage, as well as millions more without adequate coverage, can take advantage of certain “essential health benefits.” Whether offered through an employer, or purchased directly by individuals and groups, consumers can shop and compare plans at health insurance marketplaces opening in every state as of October 1, 2013. At the present time, only a small percentage of individual plans provide all 10 essential benefits. Experts believe that the race to lower premiums by insurers has resulted in cutting benefits to consumers, and that the new law will set a standard minimum for what a true health insurance should be. The 10 essential health benefits are as follows:
- Emergency Care with no pre-authorization or extra charge for out-of-network Emergency Room visits
- Outpatient Care with access to a network of doctors that should be “sufficient” in size
- Inpatient Care with patient paying a share of cost, according to patient’s out of pocket deductible limits
- Mental Health Care with a low per session charge or limited number of visits per year
- Rehabilitative therapies and services for long-term disabilities
- Preventive Services and screening without deductibles and copays except as stated in 7
- Labs and Imaging Services are not preventive when ordered as “diagnostic” and may be billed
- Prenatal, Childbirth & Infant Care free of charge to patient
- Pediatric Care in form of Dental, medically necessary orthodontic, and vision care for children under 19.
- Prescription Drugs in every class of approved medication
The devil of course is in the details! So, check the fine prints before making your selection.