ACA Has Limited Impact On Excluded Medical Services List

While the Patient Protection and Affordable Care Act (ACA) has greatly impacted both the individual and group health care markets, its effect upon the most commonly excluded medical services in health plans has been less extensive, according to recent research from Healthpocket.com. In fact, the study found that 80 percent of the excluded medical services in the top ten remained the same when comparing plans from before the ACA was enacted to plans that are available this year—and plans being sold through the health insurance exchanges must provide essential health benefits (EHBs).

EHBs. Under the ACA, qualified health plans being sold through a health insurance exchange must provide an “essential health benefits package” that has to include specific categories of benefits, meet certain cost-sharing standards, and provide certain levels of coverage. There are ten categories of EHBs: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services (including chronic disease management); and pediatric services (including oral and vision care).

Excluded services. Healthpocket.com found that in 2014, the top ten excluded services are:

      • Long-term care (99 percent of health plans exclude

 

      • Cosmetic surgery (92 percent );

 

      • Adult dental services (89 percent);

 

      • Weight loss programs (88 percent);

 

      • Acupuncture (84 percent);

 

      • Routine foot care (72 percent);

 

      • Infertility treatment (67 percent);

 

      • Private nursing (67 percent);

 

      • Adult eye exam (61 percent; and

 

    • Weight loss surgery (59 percent).

Healthpocket.com noted that the vast majority of these services also were excluded from pre-ACA plans. Two categories from the 2013 top ten list that are missing from the 2014 top ten list due to the ACA are children’s dental coverage and children’s eyeglasses, since pediatric dental and vision care are now EHBs.

For more information, visit http://www.healthpocket.com/healthcare-research/infostat/top-10-excluded-services-obamacare.

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