Obamacare excluded benefits

Under the health reforms next year an Essential Health Benefits package will change healthcare for many.

Currently, in the individual and family health insurance market there is no standardization of medical services routinely covered in the United States. A variety of important services, varying in necessity and cost, are not included in the benefits of most insurance plans.

Healthcare in the United States often appears quite daunting and expensive to expats not familiar with the system. For expats moving to the U.S., knowing what is included in their health insurance is vital, particularly for those thinking about starting a family as pre- and postnatal care is excluded in over half of insurance plans.

HealthPocket has studied over 11,000 health plans aimed at individuals and families to determine which services were most likely to be excluded from the coverage.

The vast majority (98%) of plans don’t include coverage for long-term care or cosmetic surgery, with 94 percent excluding infertility treatment.

Weight loss programmes are excluded by 93 percent of plans, while acupuncture, private nursing and children’s dental checkups are not included in 92%. Weight loss surgery (bariatric surgery) is only covered by 10 percent of the plans included in the study.

The high exclusion rate of weight loss programmes and weight loss surgery was one of the most paradoxical findings on the list. Ranked at number 23, chiropractic care is easier to obtain on your health insurance than weight loss treatment or counselling.

With the American Medical Association recently declaring obesity a disease and an estimated one third of American adults classified as obese it’s surprising that weight loss programmes aren’t more readily available.

However, until 2014, insurance plans can reject insurance applicants for medical considerations such as obesity and some insurers may have reduced their need for weight loss benefit coverage by virtue of which insurance applicants they rejected.

Affordable Care Act

The Affordable Care Act, popularly known as “Obamacare”, is due to come into force in 2014. It will require obesity screening and counseling to be included in health insurance provisions with no out-of-pocket expenses to be incurred by the patient.

What weight counselling entails depends on the insurer, it could be group therapy or telephone counselling. Coverage for weight loss surgery is not required and neither is third-party weight loss help such as Weight Watchers programmes.

Overall, the Affordable Care Act aims to normalise health insurance coverage by including a package of minimum benefits known as the Essential Health Benefits. All insurance plans will have to meet this minimum standard by January 1 2014.

In terms of the top 10 excluded benefits, the Essential Health Benefits package will introduce partial coverage for some, including children’s eyeglasses and dental checkups. One big advantage for pregnant women will be the inclusion of maternity-related benefits, including prenatal and postnatal care, and delivery.