2013-09-06 22:23:30 - The changing landscape in the health care industry will effect everyone across the USA. How will the new health care plans mandated by the Affordable Care Act (ObamaCare) stack up against current health coverage in the state of Nevada?
Beginning January 1st, 2014, Nevadan’s will be able to choose from at least 8 Individual and Family plans from four different health organizations in the Nevada State Health Insurance Exchange.
As we await the full description of the “Silver” and “Gold” plans from the Nevada Exchange, many of our insured members are asking today about the differences in the plan benefits between the plans that they have today, and the benefits for plans available in the 2014 state Exchange.
In order to offer any plan in the new Exchange, all organizations must provide at least one plan that meets the minimum “Silver” qualifications, and one plan that meets the minimum “Gold” plan definition, as described in the Affordable Care Act, sometimes known
The four providers in Nevada are Anthem Blue Cross/Blue Shield, Saint Mary’s health plans, Health Plan of Nevada, and the Nevada Health Co-op.
Both the Silver and the Gold plans from each of these four companies will provide the ten essential benefits, and 100% of the plans offered in the Exchange will be Health Maintenance Organization (HMO) plans.
The Affordable Care Act has requirements that all plans offered after January 1st, 2014, provide coverage for ten essential benefits, and these ten essential benefits include:
1. Ambulatory patient services, such as doctor's visits and outpatient services
2. Emergency services
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and Habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care
When most of our insured members see this list of ten, they often ask “Doesn’t my current plan cover these ten essential benefits already, and, yes, current plans for the majority of insured members in Nevada have coverage for 9 out of 10 of these categories. (The last item, Pediatric oral and vision services, is the exception.)
In Nevada, prior to the time that the Affordable Care Act was signed into law, all health insurance policies sold in Nevada had to be approved by the Nevada Division of Insurance. In addition to meeting the definition of “Comprehensive Coverage that is, every medical expense on every policy was included as a covered expense, except those expenses that were listed and approved by the Division of Insurance. Moreover, every policy had to comply with the 30+ mandates that are contained in the Nevada Revised Statutes. These mandates were initiated by citizens in Nevada, and signed into law in our Nevada legislature, that sought specific increases in benefits in multiple areas. Long story short, the comprehensive policies that have been approved by the Nevada Division of Insurance and are currently offered for sale in Nevada to Nevadan’s, do not have gaps in coverage.
The maximum benefit for some of the essential benefit categories may be higher with the new 2014 plans, but most plans today pay the majority of expenses that are included in 9 out of the 10 essential benefits.