In 2010 the Affordable Care Act (ACA) was signed into law, which has changed the rules of healthcare. While the new law has been met with its fair share of opposition, the aim of the ACA is to make coverage more accessible and affordable for Americans. Below we’ll briefly explore the impact of the ACA on employees.
The ACA mandates that insurance companies can no longer deny people coverage for preexisting conditions, and it established a federal health insurance exchange with subsidized coverage to those who qualify. Many states elected to create their own state-run exchanges.
Expanded Coverage Includes Preventive Care and “Essential Health Benefits”
The ACA also mandates that all plans issued after March 23, 2010 must cover certain preventive services at no cost to the consumer, and plans must also cover 10 essential health benefits.
Among the preventive services that must be covered on newer plans are: blood pressure screening; type 2 diabetes screening; immunization vaccines, including, but not limited to, hepatitis A and B, MMR, TDP, and others; and obesity screening and counseling, among other services1.
In addition to preventive services, plans issued after March 23, 2010 must include the following 10 essential health benefits2:
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Ambulatory (outpatient) patient services
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Emergency services
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Hospitalization
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Maternity and newborn care
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Mental health and substance use disorder services, including behavioral health treatment
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Prescription drugs
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Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning), and devices
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Laboratory services
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Preventive and wellness services, and chronic disease management
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Pediatric services, including oral and vision care
It’s important to note that many individual and group health plans issued before March 23, 2010 may be “grandfathered”—that is, exempt from some of the requirements of the new law. For more information about “grandfathered” plans, visit
healthcare.gov
. To determine whether your plan has grandfathered status, contact your insurance carrier.
All in all, the new healthcare law expands coverage and makes many preventive and essential health services more accessible. This can ultimately benefit not only employees, but businesses, as a healthy workforce tends to reduce insurance costs and absenteeism. The incorporation of additional benefits into newer healthcare policies can provide a boost to comprehensive employer health wellness programs.
Our next post will cover how the ACA affects employers of varying sizes.
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