Tag Archives: essential benefits

During open enrollment, consumers will need help recognizing plans that comply with the Affordable Care Act

questions1Journalists covering open enrollment for the Affordable Care Act this year will need to separate fact from fiction about the law and about coverage for pre-existing conditions.

As we saw on Tuesday, the U.S. Supreme Court heard oral arguments on whether it should strike down the individual mandate and the entire ACA in a case we covered in a blog post on Monday. One of the big issues in any debate involving the ACA is coverage for Americans who have pre-existing conditions. During the coronavirus pandemic, this issue is even more important than it was in previous years because more than 10 million cases have been reported, according to The New York Times. Many of those Americans now have a pre-existing condition they did not have last year. Continue reading

Actuaries report on shortcomings of short-term, limited-duration health plans

In a new study, Milliman actuaries compared costs under health insurance plans that comply with the requirements of the Affordable Care Act versus costs of short-term health plans that do not meet the ACA’s requirements.

Milliman actuaries compared costs under health insurance plans that comply with the requirements of the Affordable Care Act versus costs of short-term health plans that do not meet the ACA’s requirements.

New research about short-term, limited-duration health plans shows that none of the plans studied covered pre-existing conditions and all had coverage limits, according to a new report from Milliman, an actuarial consulting firm. Only one-third of the plans covered prescription drugs and only 42% covered mental health, according to the report.

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Similar health reform terms, but very different concepts

Essential health benefits include maternity and newborn care.

Photo: David Castillo Dominici via FreeDigitalPhotos.net 
Essential health benefits include maternity and newborn care.

We’ve had a few members wonder whether “essential coverage” and “essential benefits” are one and the same.

They aren’t – and we’ve done a tip sheet to explain the difference in more detail.

But here’s the quick version:

If someone has minimum essential coverage it means he or she has a health plan that complies with the individual mandate. It means that there will be no penalty when 2014 taxes are filed. A lot of health plans qualify, including the exchange plans, most plans in the individual and small group market, employer-based health plans, Medicare, Medicaid.

Limited plans such as workers’ compensation or dental-only plans do not qualify as mandate-meeting minimum essential coverage.

Essential health benefits are the 10 categories of benefit s – hospitalization, prescription drugs, maternity care, etc. – that the exchange plans and the ACA-compliant off-exchange plans must cover. (After the brouhaha about plan cancellations, the administration gave states the option of extending the noncompliant plans for a few more years. They can be minimum essential coverage – but they don’t have essential health benefits.)

See the tip sheet for more explanation.

After AHCJ protest, HHS stipulates public meetings are open to media

Can you imagine holding public meetings open to everyone – except reporters who want to cover them? That’s exactly what the U.S. Department of Health and Human Services did last year. But, after complaints from the Association of Health Care Journalists, HHS has agreed to make it a policy that public meetings are open to the media.

“We are hopeful this will not happen again,” said Felice Freyer, chair of AHCJ’s Right to Know Committee. “But to make sure, we will need your help.”

Here’s what happened:

In November, HHS held a series of “listening sessions” in 10 cities to gather input on an important aspect of the Affordable Care Act. These meetings were publicized among thousands of invited “stakeholders,” and anyone who heard by word of mouth could also attend.

But apparently no media advisories went out and, worse, reporters who happened to learn about the meetings were barred from attending.  The meetings were not transcribed or recorded.

AHCJ learned about these meetings from Laura Newman, an independent medical journalist and blogger at Patient POV, who asked to attend and was told she could not. Alarmed that the government would bar coverage of public meetings, AHCJ wrote to every member working in the cities where the listening sessions were held (Chicago, Boston, Philadelphia, Dallas, New York, Kansas City, Atlanta, Seattle, Denver and San Francisco) to find out what they knew.  Among the 26 who replied, only two knew about the meetings before they took place – Newman and another member who had not been interested in attending.

Over a period of weeks, AHCJ worked with the HHS media office to find out what had happened and to express our concerns. “By excluding the news media, HHS was essentially shutting the door on the majority of people who weren’t on the mailing list or connected with someone who was,” Freyer said. “Most people don’t go to such events, but rely on the news media to tell them what happened.”

The meetings sought input on the definition of “essential benefits,” the minimum that would be covered by plans sold on health insurance exchanges. This was a key aspect of carrying out the health care law; in the end, HHS decided to leave that question to the states.

We asked for the list of “stakeholders” who attended and any notes from the meetings, but HHS was unable to provide them. In a phone conversation last month with Freyer and AHCJ president Charles Ornstein, HHS media officials acknowledged that such meetings should be open to the media.  At our request, they agreed to add this sentence to their media guidelines: “Meetings that are open to the public are, by definition, open to the media.”

Please watch out for any violations of this principle, and let us know about them.

“This incident illustrates how members can make a big difference by alerting us to access problems,” Ornstein said. “We’re grateful to Laura Newman for bringing this to our attention, and to all those who responded to our letter. The work of the Right to Know Committee is among AHCJ’s most important endeavors – but none of it can happen without our members’ vigilance and willingness to step forward with information.”