Consumers Should Be Top Priority as 2014 Health Benefit Packages Are Set

Institute of Medicine Meets This Week to Help Shape Benefits

WASHINGTON, D.C.—An important meeting convened Wednesday to help shape the basic health care benefit package under the Affordable Care Act, and Families USA is urging the Institute of Medicine and the Department of Health and Human Services to ensure that health coverage benefits are adequately responsive to consumers’ health care needs.

Under the Affordable Care Act, health plans in the individual and small group markets will have to include coverage for certain general categories of benefits that are essentially equal to what is covered under a typical employer plan. On Wednesday, the Institute of Medicine convened a three-day meeting to make recommendations to HHS on what provisions this essential health benefits package should contain.

Almost 41 million Americans now get their coverage through small group plans, and 16.7 million get their coverage through individually purchased policies. The essential benefit package is intended to ensure that consumers receive the health services they need to become and to stay healthy. Starting in 2014, the benefit package must include an expanded list of important services: ambulatory care, emergency services, prescription drugs, mental health care, maternity and newborn care, rehabilitative and habilitative services, laboratory services, preventive and wellness services, chronic disease management, pediatric services, and oral and vision care. Some of these benefits are now often left out of individual insurance plans.

“Health insurance is only meaningful if it provides adequate coverage,” Ron Pollack, Executive Director of Families USA, said today. “It is essential that the definitions of guaranteed benefits and services fulfill the goal of improving and protecting Americans' health.  

“It all sounds so logical, but children should have the services they need for healthy development, people who are sick should have treatment they need to get well, and people with disabilities should have the care and services they need to maximize their functioning,” Pollack said. “The essential benefit package will help Americans get the care they need. No longer will consumers be surprised to find that the essential care they need is not covered by their health plans.”

Various studies have shown that many people, particularly those who buy coverage in the individual market, currently go without some coverage that will be provided in 2014:

• Twenty-two percent of people who purchase their own insurance are surprised to find their plan will not pay anything for care they thought was covered.
• Twenty percent of individual plans do not include any coverage for prescription drugs.
• Fifty-seven percent of individual plans do not include any coverage of maternity care.
• Fifty-two percent of individual plans do not include any coverage for outpatient mental health care, and more than a third (37 percent) do not include any coverage for inpatient mental health care.

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Families USA is the national organization for health care consumers. It is nonprofit and nonpartisan and advocates for high-quality, affordable health care for all Americans.

1201 New York Avenue NW, Suite 1100 · Washington, DC 20005
202-628-3030 · Email: info@familiesusa.org · www.familiesusa.org