496:
benefits are not unduly weighted toward any category"; (2) may "not make coverage decisions, determine reimbursement rates, establish incentive programs, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life"; (3) must take into account "the health care needs of diverse segments of the population, including women, children, persons with disabilities, and other groups"; and (4) must ensure that essential benefits "not be subject to denial to individuals against their wishes on the basis of the individuals’ age or expected length of life or the individuals' present or predicted disability, degree of medical dependency, or quality of life."
312:
323:
508:
by many state officials, who valued the opportunity to tailor benefit standards to reflect state priorities, and by insurers, who retained more control over benefit design. Groups representing consumers and providers were less supportive, however, expressing concern that the degree of flexibility found in the rules undermines the law's promise of consistent, meaningful coverage.
507:
As it stands, federal regulations for 2014 and 2015 do not establish a single, nationally uniform package of health services. Instead, the U.S. Department of Health and Human
Services (HHS) gave states discretion to determine the specific benefits they deem essential. This approach was well-received
495:
to determine, through regulation, what specific services within these classes are essential. However, the Act provides certain parameters for the secretary to consider. The secretary (1) must "ensure that such essential health benefits reflect an appropriate balance among the categories ... so that
606:
826:
537:, with insurers cutting benefits to lower premiums." The establishment of essential health benefits "set a standard for insurance. Anything below that is not true health insurance." The EHB requirement came into effect on January 1, 2014.
490:
The essential health benefits are a minimum federal standard and "states may require that qualified health plans sold in state health insurance exchanges also cover state-mandated benefits." The act gives "considerable discretion" to the
572:, while EHBs are a set of benefits that qualified health plans (QHPs) must offer. MEC is a low threshold; many forms of coverage that do not provide essential health benefits are nevertheless considered minimum essential coverage.
697:
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195:
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Allowing states to define “essential health benefits” could weaken ACA protections against catastrophic costs for people with employer coverage nationwide.
344:
170:
83:
1282:
114:
44:
77:
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The
Affordable Care Act (ACA) set forth the following ten categories of essential health benefits, at Section 1302(b)(1) of the ACA, codified at
337:
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210:
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plans, and ERISA-governed multi-employer welfare arrangements that are not subject to state insurance law are exempted from the requirement.
49:
1328:
987:
380:(ACA) of 2010, that must be covered by individually-purchased health insurance and plans in small-group markets both inside and outside of
867:
779:
635:
622:
518:
164:
95:
727:
The Health Care Law's 10 Essential
Benefits: The Affordable Care Act ensures you'll have access to these medical and wellness services
205:
726:
1313:
522:
385:
1277:
492:
108:
31:
807:
Understanding the
Difference between Minimum Essential Coverage, Essential Health Benefits, Minimum Value, and Actuarial Value
982:
941:
530:
1184:
445:
533:
Center for Health Policy
Research, explained that before the ACA's passage, U.S. health insurance sector experienced "a
397:
70:
1124:
541:
151:
133:
1287:
972:
894:
120:
824:
The
Essential Health Benefits Provisions of the Affordable Care Act: Implications for People with Disabilities
607:
The
Essential Health Benefits Provisions of the Affordable Care Act: Implications for People with Disabilities
1349:
1036:
936:
754:
381:
1244:
1074:
243:
1144:
1054:
526:
238:
233:
1323:
569:
248:
1104:
854:
842:
Implementing the
Affordable Care Act: Revisiting the ACA’s Essential Health Benefits Requirements
288:
1234:
1006:
283:
228:
23:
863:
540:
Revision and repeal of essential health benefits coverage was proposed in the
Republican part
1292:
946:
479:
265:
145:
1297:
316:
260:
139:
8:
921:
917:
903:
887:
755:"Republicans may gut an overlooked provision of Obamacare — and disrupt health insurance"
470:
451:
377:
1240:
1194:
1174:
1064:
967:
534:
411:
327:
1114:
834:
731:
610:
500:
439:
1190:
1090:
1084:
685:
581:
568:). MEC is the minimum amount of coverage that an individual must carry to meet the
1224:
1018:
830:
642:
460:
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423:
417:
405:
293:
1259:
1094:
1044:
880:
858:
545:
298:
1343:
1150:
478:
Health insurance plans must cover these benefits i.e. they must cap people's
433:
365:
1220:
1210:
1204:
436:
and substance use disorder services, including behavioral health treatment.
1080:
636:
10 Essential Health
Benefits Insurance Plans Must Cover Starting in 2014
1180:
1060:
466:
872:
1160:
549:
517:
Coverage of essential health benefits was first required by the 2010
1318:
1140:
1130:
1120:
1070:
1050:
623:
10 health care benefits covered in the Health Insurance Marketplace
525:
legislation. The EHB provisions of the ACA was an amendment to the
1230:
548:
members lobbied during legislation discussion with House Speaker
427:
1214:
1200:
1170:
1164:
1134:
1100:
864:
Information on Essential Health Benefits (EHB) Benchmark Plans
1110:
866:
from the Consumer Information and Insurance Oversight of the
686:
42 U.S. Code § 18022 - Essential health benefits requirements
555:
552:
to remove EHBs as a condition for approval of the AHCA bill.
932:
Provisions of the Patient Protection and Affordable Care Act
978:
Authority for Mandate Delay Act (H.R. 2667; 113th Congress)
840:
Justin Giovannelli, Kevin W. Lucia & Sabrina Corlette,
529:. Lavarreda, director of health insurance studies for the
657:"Essential Health Benefits Under The Affordable Care Act"
1026:
National Federation of Independent Business v. Sebelius
822:
Sara Rosenbaum, Joel Teitelbaum & Katherine Hayes,
605:
Sara Rosenbaum, Joel Teitelbaum & Katherine Hayes,
560:
Essential health benefits should not be confused with
926:
Health Care and Education Reconciliation Act of 2010
1355:Healthcare reform legislation in the United States
801:
799:
700:Washington, DC: Brookings Institution, 2 May 2017
482:and must not limit annual and lifetime coverage.
1341:
1283:America's Affordable Health Choices Act of 2009
780:"Essential Health Benefits and why they matter"
376:) are a set of ten benefits, defined under the
796:
625:, HealthCare.gov (accessed November 12, 2015).
888:
345:
988:Patient-Centered Outcomes Research Institute
171:Health Care and Education Reconciliation Act
721:
719:
717:
715:
521:(PPACA or ACA), which was a major piece of
922:Patient Protection and Affordable Care Act
918:Patient Protection and Affordable Care Act
895:
881:
868:Centers for Medicare and Medicaid Services
628:
556:Comparison with minimum essential coverage
519:Patient Protection and Affordable Care Act
352:
338:
384:. Large-group health plans, self-insured
744:Rosenbaum, Teitelbaum & Hayes, p. 2.
712:
709:Giovannelli, Lucia & Corlette, p. 2.
1314:Health care reform in the United States
902:
16:Benefits covered by insurance in the US
1342:
1278:Affordable Health Care for America Act
654:
601:
599:
597:
493:Secretary of Health and Human Services
448:and habilitative services and devices.
1360:Health insurance in the United States
983:Contraceptive mandate (United States)
876:
1185:New Mexico Health Insurance Exchange
809:, Leavitt Group (January 27, 2014).
594:
570:individual health insurance mandate
115:America's Affordable Health Choices
13:
805:Susan Grassli & Lisa Klinger,
109:Affordable Health Care for America
71:Social Security Amendments of 1965
14:
1371:
1125:Illinois Health Benefits Exchange
848:
844:Commonwealth Fund (October 2014).
777:
655:Folger, Jean (October 11, 2013).
485:
645:, FamiliesUSA (March 28, 2013).
542:American Health Care Act of 2017
321:
310:
973:Physician Payments Sunshine Act
771:
747:
738:
703:
690:
679:
648:
616:
512:
191:Obama administration proposals
1:
1037:Health insurance marketplaces
391:
382:health insurance marketplaces
1288:America's Healthy Future Act
937:Health insurance marketplace
7:
1245:Washington Healthplanfinder
1075:Connect for Health Colorado
575:
406:Ambulatory patient services
10:
1376:
1255:Federal insurance exchange
1155:Health Insurance Connector
1145:Maryland Health Connection
1047:, an option for all states
816:
562:minimum essential coverage
459:and wellness services and
278:Third-party payment models
90:Medicare Modernization Act
1306:
1266:
1254:
1055:Arkansas Health Connector
1035:
998:Constitutional challenges
996:
963:Essential health benefits
955:
910:
855:Essential Health Benefits
527:Public Health Service Act
370:essential health benefits
234:Health insurance exchange
735:(August/September 2013).
587:
317:United States portal
134:American Health Care Act
33:Healthcare reform in the
22:This article is part of
1270:from the 111th Congress
1105:Hawaii Health Connector
1268:Other reform proposals
1235:Vermont Health Connect
1007:Burwell v. Hobby Lobby
942:Contraceptives mandate
510:
480:out-of-pocket spending
328:Health care portal
284:All-payer rate setting
239:Nationalized insurance
201:Reform advocacy groups
1293:Healthy Americans Act
947:Executive Order 13535
505:
254:Canadian vs. American
146:Healthy Americans Act
1298:Medicare for All Act
469:services, including
140:Medicare for All Act
1350:Affordable Care Act
904:Affordable Care Act
452:Laboratory services
378:Affordable Care Act
165:Affordable Care Act
152:Health Security Act
1195:NY State of Health
1175:Nevada Health Link
1065:Covered California
968:Premium tax credit
829:2016-10-20 at the
641:2018-01-29 at the
535:race to the bottom
523:health care reform
440:Prescription drugs
412:Emergency services
211:Insurance coverage
121:Baucus Health Bill
1337:
1336:
1115:Your Health Idaho
1013:Coons v. Geithner
835:Commonwealth Fund
732:AARP The Magazine
634:Alexandra Ernst,
611:Commonwealth Fund
501:Commonwealth Fund
362:
361:
142:(2021, H.R. 1976)
36:
1367:
1085:Access Health CT
897:
890:
883:
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769:
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759:Business Insider
751:
745:
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723:
710:
707:
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694:
688:
683:
677:
676:
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667:on July 28, 2017
663:. Archived from
652:
646:
632:
626:
620:
614:
603:
582:Broccoli mandate
503:report in 2011:
473:and vision care.
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1262:
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1225:HealthSource RI
1031:
1019:King v. Burwell
992:
951:
906:
901:
851:
831:Wayback Machine
819:
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788:
786:
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748:
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713:
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661:Forbes Magazine
653:
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643:Wayback Machine
633:
629:
621:
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558:
515:
499:According to a
488:
476:
461:chronic disease
418:Hospitalization
394:
358:
322:
320:
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311:
309:
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294:Fee-for-service
279:
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244:Publicly-funded
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61:
34:
17:
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1272:
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1260:HealthCare.gov
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1108:
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1095:DC Health Link
1088:
1078:
1068:
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1048:
1045:HealthCare.gov
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859:HealthCare.gov
850:
849:External links
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546:Freedom Caucus
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486:Interpretation
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446:Rehabilitative
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839:
837:(March 2011).
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800:
785:
781:
778:Luhby, Tami.
774:
760:
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741:
734:
733:
728:
725:Frank Lalli,
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619:
613:(March 2011).
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434:Mental health
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35:United States
30:
29:
25:
21:
20:
1205:Cover Oregon
1024:
1017:
1012:
1005:
962:
911:Key articles
787:. Retrieved
783:
773:
762:. Retrieved
758:
749:
740:
730:
705:
692:
681:
669:. Retrieved
665:the original
660:
650:
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618:
565:
561:
559:
539:
516:
506:
498:
489:
477:
400:§ 18022(b):
395:
373:
369:
363:
249:Single-payer
148:(2007, 2009)
696:Fiedler M.
513:Law history
463:management;
229:Free market
174:(H.R. 4872)
167:(H.R. 3590)
154:(H.R. 3600)
117:(H.R. 3200)
111:(H.R. 3962)
60:Legislation
1344:Categories
956:Provisions
789:2017-03-26
764:2017-03-26
457:Preventive
392:Definition
289:Capitation
103:Superseded
550:Paul Ryan
467:Pediatric
424:Maternity
398:42 U.S.C.
266:Universal
206:Rationing
123:(S. 1796)
65:Preceding
1324:Medicare
1319:Medicaid
1307:See also
827:Archived
671:July 28,
639:Archived
576:See also
544:. House
261:Two-tier
128:Proposed
24:a series
817:Sources
428:newborn
364:In the
223:Systems
185:Reforms
45:History
1215:Pennie
1165:MNsure
1135:Kynect
136:(2017)
98:(2005)
92:(2003)
86:(1996)
80:(1986)
78:EMTALA
50:Debate
1329:SCHIP
857:from
588:Notes
386:ERISA
96:PSQIA
84:HIPAA
924:and
673:2017
531:UCLA
471:oral
430:care
426:and
374:EHBs
784:CNN
566:MEC
1346::
1241:WA
1231:VT
1221:RI
1211:PA
1201:OR
1191:NY
1181:NM
1171:NV
1161:MN
1151:MA
1141:MD
1131:KY
1121:IL
1111:ID
1101:HI
1091:DC
1081:CT
1071:CO
1061:CA
1051:AR
833:,
798:^
782:.
757:.
729:,
714:^
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