ACA excluded medical services list remains intact: study

As Affordable Care Act health plans continue their rollout, a new nationwide analysis finds that public health exchanges continue to exclude the same medical services, across the board.

HealthPocket, a technology company that compares and ranks all the health plans available, discloses that the top three excluded benefits include long-term care (99%), cosmetic surgery (92%) and adult dental services (89%).

Between 2013 and 2014, approximately 80% of the top 10 exclusion services were virtually the same, according to the more than 3,000 health plans analyzed in the individual and family health insurance market.

“While the Affordable Care Act has exerted an enormous influence over the individual health insurance market, its effect upon the most commonly excluded medical services has been less extensive,” notes Kev Coleman, head of HealthPocket’s research and data. “Most of the health care services excluded in the pre-reform market have remained in the Obamacare era.”

Under the ACA’s essential health benefits requirement, the research notes that 2014 changes to individually purchased health plans include adding pediatric dental and vision. The insurance researcher looked at all four ACA metal plans, including bronze, silver, gold and platinum options.

Also, HealthPocket’s research mandates that while obesity screening and obesity counseling are categorized as mandatory under preventative care options, there is a divide when looking at obesity-related preventative services and weight loss programs. There was a five percentage point dip to 88% for weight loss programs not covered in these plans; up to 59% do not cover the weight loss surgery option, according to the February 2014 figures.

Moreover, infertility treatments are also excluded for more than two-thirds of individually purchased ACA plans.

HealthPocket’s Coleman notes in the report that these excluded services “are not likely to have the same public significance as over health care spending, premium inflation and network provider breadth.” He adds that the medical services list is likely to be addressed at the state level.

In a prior PricewaterhouseCooper’s Health Research Institute analysis, it was revealed that premiums for health plans on new state exchanges under the Affordable Care Act are comparable to – and in some cases lower than – those being offered by employers with similar levels of coverage. Others companies have decided to launch join private exchanges or create their own health programs due to a demand from consumers.

The ACA allows for consumers to shop on its 51 new state exchanges within four plan levels; these include bronze, which pays 60% of health care costs; silver, which covers 70%; gold, which covers 80%; and platinum, which covers 90% of the bill. Currently, employer-sponsored health plans cover about 85% of health care costs, with the remaining costs being charged to employees, the prior PwC study stated.