Tuesday 21 Oct 2014

Information and opinions presented here do not always represent the views of the American Heart Association.

Affordable Care Act offers essential health benefits to consumers

Published: 11:41 am CDT, October 14, 2013

In the past, even with health insurance, a serious heart attack or stroke could mean financial disaster.

For example, some types of health plans excluded coverage for basic care, such as prescription drugs or hospital services. Or the plans imposed low annual coverage limits of  $5,000 or $10,000.  Often consumers didn’t realize how inadequate their coverage was until they became ill.  

Because there was a huge number of these “limited benefit” or “mini-med” plans, many Americans faced high healthcare bills. More than 60 percent of people who filed for bankruptcy in 2007 did so because of medical bills. Nearly 80 percent of those people actually had medical insurance, while 25 percent were people with cardiovascular disease.

The Affordable Care Act requires health plans sold to individuals and small businesses — including those sold through the new Marketplaces — to cover a comprehensive benefits package that should ensure Americans will have access to care and the financial security promised by insurance.

The health insurance plans, which will be available by Jan. 1,  must cover a core set of patient services called “Essential Health Benefits.” The 10 categories of benefits will include a wide range of services important to heart and stroke patients, such as:

  • Ambulatory and emergency services
  • Hospital care
  • Physician office visits
  • Prescription drugs
  • Lab tests
  • Rehabilitative care
  • Preventive screenings/services
  • Chronic disease management

Each state chose its essential health benefits package.  The benefits guaranteed are similar in scope to those included in a health insurance plan provided by an employer.  However, while the specific services covered within a category may vary from plan to plan and from state to state, insurance policies must cover all 10 categories of essential benefits in order to be sold to individuals and small employers.  

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