“Essential benefits” disappeared last night from the health care bill that aims to replace the Affordable Care Act. If it passes, health insurance plans would no longer be required to cover maternity care. Or hospitalization. Or emergency care. Or prescription drugs. That means these circa-2010 terrible health plans could make a comeback!
Insurance plans offered by employers tended to be pretty good, if you were lucky enough to be offered one. But if you needed to buy insurance on your own, or if you worked for a stingy employer like McDonald’s, your plan might cover very little.
The plan above, Value Health USA, only cost $91 a month, and it doesn’t look like such a bad deal at first glance—there’s no deductible and if you need surgery it will pay you up to $10,000. But benefits are limited across the board: only $500 for a day’s hospitalization, even though the average cost in 2010 was over $1600. You get $125 for emergency treatment, but the average cost was $969. The company offered extra coverage for emergency room visits, for an extra $20/month, if you plan on having emergencies. Plan them well, because Value ER only covers two emergencies per year.
Of course, the plan above doesn’t cover any pre-existing conditions, prescription drugs, maternity care, mental health care, or treatment or screening for alcohol or drug abuse. Your mammograms won’t be covered, or vaccines, or anything else, really. “Do not assume that an expense not listed is a covered item,” they say in the fine print.
Maybe you’d like to shop around. Okay, how about the “good” plan from Assurant? It sort of covers surgery, but only $250/year worth and only if the surgery happens during an office visit. There’s zilch for anesthesia, hospitalization, ambulance rides, or emergency care. Or try the Standard Plan from IHC: they’ll give you $150/year toward preventive care and $100/day if you’re hospitalized, but very little else. The plan doesn’t even cover x-rays or blood draws.
All of the prices above are in 2010 dollars, so $100 back then means $110 today. Health care costs have risen faster than inflation, though, so even if these exact plans came back they would probably be a lot more expensive.
If you bought a plan like this in 2010, don’t think you would have realized its limitations. Plenty of people were burned by minimal benefit plans, not understanding their limitations or not realizing just how much hospitals can charge. Consumer Reports warned about plans like these, but acknowledged that many folks don’t have a choice to buy anything better.
Most individual plans in 2010 covered less than 60 percent of your care—in other words, they’re worse than the “bronze” level that is currently the minimum allowed to be sold. Last week, the Congressional Budget Office said we weren’t likely to go back to those days, because the essential benefits are still in place, so plans still have to cover most of the important stuff. With the new tweak to the bill, that promise is gone.
Can states set their own lists of essential benefits? Sure, and some did in pre-ACA days, too. Most states opted not to require mental health care, maternity care, or the other benefits that are now on the chopping block. And without those mandates, it could be impossible to find a plan you could afford that covered basic care. In 2009, the National Women’s Law Center found that only 13 percent of plans available to 30-year-old women covered maternity care. Those plans cost extra, of course, and many women simply couldn’t afford them.
You would be in the same boat if you needed mental health care, treatment for drug addiction, or any other costly condition that insurers didn’t want to touch. If you don’t want to go back to those days, give your representative a call.