You may have heard of the ten essential health benefits that come with Obamacare-compliant health insurance plans. But what’s “essential” may differ for each individual person–making the question “what are the most important health insurance benefits?” very hard to answer. Although the answer to this question is probably different for everyone, eHealth does have information on what our customers value the most when it comes to health benefits on their insurance plans. Before we dive into that, though, let’s look at what the government believes are essential to any health insurance plan.
What are Essential Health Benefits?
With the Affordable Care Act (ACA), came the ten essential health benefits. These benefits include covering doctors, inpatient healthcare, prescriptions, maternity, and mental health. In addition, health insurance plans for children must help pay for dental services. While insurers can include other health insurance benefits, they have to offer this mandated coverage in any policy sold as a qualified, major medical health insurance plan.
Some non-qualified plans, like short-term health insurance plans, don’t have to offer all of this protection. In turn, non-qualified health insurance plans may cost less. Faced with increasing premiums for a qualified health insurance plan, consumers, insurance companies, and government officials still discuss this issue.
Proponents of mandated health insurance benefits say that they help ensure the consumers get coverage they may need; however, opponents wonder if everybody should be forced to pay more for health insurance plans that include benefits that they might not use.
These services include lab tests like common blood count (CBC), urinalysis (urine), microbiology (tests for bacteria and other microscopic organisms, and pathology for organs and tissues.
This service is for patients seeking immediate medical attention and is open 24 hours.
Prescription drugs are medications taken by a patient to treat a certain health condition. These drugs are prescribed according to the medical condition you have.
Mental health & substance use disorder services
Mental disorders, such as changes in thinking, mood, or behavior, are covered under this benefit. If you suffer from similar conditions, you can seek help in these centers.
Maternity and newborn care
This service is provided for mothers who are about to give birth and for newborns. The services include care for the mother and baby throughout the pregnancy, during birth, and after birth. Critical care for newborns in the first days after birth is also provided.
This benefit includes all services provided to infants and children. Vaccines, immunization, dental services, and annual vision screenings are all included in the service.
Rehabilitative & habilitative services & devices
These services are for people who need help in improving their daily activities. These can be physical therapy, speech-language pathology, and other therapies for people with disabilities.
Ambulatory patient services
Ambulatory is a service you get without staying in a hospital. This includes the services you get in the clinic, emergency room, the doctor’s office, or in the ambulatory surgery center.
Preventive & wellness services & chronic disease management
These services include vaccines and screenings that are mainly done to prevent diseases. Wellness services include weight management and stress reduction treatments to help you live a healthier lifestyle.
Hospitalization is a health event that requires you to stay within the hospital to get treatment and to monitor your conditions.
Which health insurance benefits do consumers value the most?
The cobra insurance network survey asked consumers which health insurance benefits they thought insurance companies should offer:
- 60 percent
- 55 percent
- 61 percent
- 38 percent
A majority or large minority of survey responses did agree with at least some of the essential health insurance benefits. An overwhelming 89 percent of respondents said that plans should include preventative care, and 80 percent thought that a health insurance plan should also cover emergency care. However, when asked which benefits they would pay more for, only preventative and emergency care earned a majority of positive responses. While consumers like and understand the idea of mandating benefits, they already may feel as if premiums stretch their budgets. Responses varied somewhat by gender and age. For instance:
- About 66 percent of women viewed maternity coverage as positive; however, that percentage dropped to only 28 percent if that benefit added to the premiums.
- Out of people of either gender who were past age 44, only four percent said they would want to pay more for a health insurance plan that covered maternity.
- Similarly, almost 70 percent of consumers under 35 thought that a health plan should include birth control. While about 38 of younger adults would pay for it, only four percent of adults over 45 agreed.
Does it make sense to allow people to pick and choose the benefits that they want? It’s easy to understand, for instance, why an older or single man may not think it’s fair to pay extra for maternity benefits. On the other hand, younger women may also pay more for emergency care, a service they are not as likely to use as a middle-aged man. By having everybody pay for all of the benefits, insurers may spread risks and premiums among a larger population. Also, people can’t always predict when they will need various medical benefits, so covering everybody helps protect them. Still, concerns over high health insurance premiums plague plenty of people, and eliminating some benefits may help reduce them. Obviously, people on both sides of this issue make solid points, and people will continue to discuss it.
What should healthcare include?
Healthcare should include essential health benefits. These essential health benefit requirements are defined by the Affordable Care Act and provide individuals and small groups with access to holistic coverage that meets their vital needs.
These essential health benefits will fall into a few core categories, including:
- Outpatient basis care services
- Medical emergency services
- Inpatient and hospital care
- Newborn and maternal related care
- Mental wellbeing and disorder care
- Prescription medication
- Rehabilitative service
- Laboratory services