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Half of Americans with individual health plans could gain better coverage under the ACA
Date:5/25/2012

ered health plans in the individual and small-group markets, those that were not in existence when the Affordable Care Act was passed in 2010, will also have to meet these requirements. Insurance carriers selling in the exchanges and in the individual and small-group markets must provide consumers and businesses with a comprehensive package of health care services, known as essential health benefits. Consumers can choose plans with the essential health benefits that vary by four distinct levels of cost-sharing: bronze, silver, gold, or platinum. Platinum plans cover on average 90 percent or more of health expenses, while bronze plans must cover a minimum of 60 percent. More than half of the plans currently offered on the individual market cover less than 60 percent of expenses and wouldn't qualify for the exchanges.

The Affordable Care Act also requires health plans offered in the exchanges and the individual and small-group markets to cap annual out-of-pocket expenses at $6,050 for individuals and $12,100 for a family. Families with low and moderate incomes will qualify for even lower out-of-pocket spending caps. Under health reform, insurers can also no longer deny coverage to people with pre-existing conditions, or set premiums based on how healthy they are.

Gabel and his colleagues analyzed individual plans and employer-based group plans offered on the market in 2010 to see how they would stack up under these requirements. The researchers based their findings on simulated bill-paying from a national sample of employer-based group plans and a five-state sample of individual plans. The five states sampled were California, Florida, Michigan, Pennsylvania, and Utah.

Individual Insurance Plans

The study found that 51 percent of Americans with individual insurance in 2010 had plans the authors classified as "tin," because they lacked essential benefits required by the law, such as coverage for behavioral health and maternity care,
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Contact: Mary Mahon
mm@cmwf.org
212-606-3853
Commonwealth Fund
Source:Eurekalert

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