Essential Health Benefits


In order to qualify for the ACA’s tax credits, you must have health insurance coverage that covers the ten essential health benefits. Individually-purchased health insurance and plans sold in small-group markets must provide these benefits. These benefits are also required for many government-sponsored health programs. Read on to learn more about essential health benefits. This article outlines what each type of health insurance coverage must provide. If you do not have health insurance coverage, you must find another plan to meet your needs.

The Institute of Medicine issued guidance for the Department of Health and Human Services on how to implement an essential health benefits package. The report is not binding, but recommends a framework for selecting covered services and benefits. The Institute of Medicine explicitly states that state-mandated benefits should be subject to the same medical effectiveness review process as federally mandated benefits. Despite these recommendations, many states still have not enacted a comprehensive essential health benefit package.

While the Trump Administration halted the cost-sharing reductions, they have not yet imposed the full list of essential health benefits. While many have expressed concern that the inclusion of state-mandated benefits will raise premiums, the HHS estimates that it will have only a minimal effect on premiums. However, groups representing insurers and employers hope that the new regulations will be modified by the 2016 deadline and that only those benefits with strong evidence of medical effectiveness will be included in the essential health benefits package.

These regulations do not affect grandmothered plans. They are applicable to every individual and small-group policy sold since January 1, 2014. This means that, by 2021, there will be 11.3 million people with on-exchange coverage in the individual market. A special enrollment period for COVID-related health plans will increase this number even further. The IOM also notes that, as of now, most insurers are providing coverage to at least 74 percent of their employees.

The Affordable Care Act requires that all health plans offer essential health benefits to their employees. They must also cover prescription drugs. Additionally, insurers are prohibited from imposing annual or lifetime caps on coverage. They are still allowed to restrict the number of covered visits. Whether your plan provides these essential health benefits will depend on your coverage. But, you should always make sure to read the fine print. You want to ensure that you have access to the best health care. You need to be protected from unnecessary expenses.

The Affordable Care Act mandates that health plans cover essential health benefits without annual dollar caps. Previously, these benefits were covered unevenly and patients were faced with unexpected dollar limits. Thankfully, this new law will bring some much needed peace of mind to those who are struggling with mental health and substance abuse issues. These services must be just as comprehensive as medical services. So, if you are looking for affordable, comprehensive health insurance, make sure your plan offers these essential health benefits.

Leave a Reply

Your email address will not be published. Required fields are marked *