Insurers Slacking on ACA Regulations for Individual Plans


According to a recent study published in the journal Health Affairs, individual health insurance plans are not what they should be. Despite the health reform bill being disputed in the Supreme Court, its regulations are still in effect, a fact that insurance companies seem to be neglecting. In regards to individual health insurance, “more than half of all medical insurance policies sold to individuals now fail to meet the standards of coverage set by the federal health care law under review by the Supreme Court” (Abelson, NYtimes.com).

There are benefits to protect the policy-holder, such as coverage for treatment of a pre-existing condition, maternity care, that should be upheld in an individual policy under the Affordable Care Act. The insurance companies are still excluding these federally mandated benefits, and taking their own liberties as they did prior to the bill. They also are required to set lower rates for premiums and copayments, regardless of the person’s health status.

The Affordable Care Act distinctly set standards for “essential benefits”, which all states must comply with in order to have their own state-based health exchanges. The exchanges will be effective as of 2014, but they are so far not providing thorough and quality coverage as required by the ACA. Coverage for individuals is also supposed to be on par with that of a group policy under the act.

“The study found that some families who have very high medical expenses can pay $27,000 or more in out-of-pocket costs toward their care.” (Abelson, NYtimes.com) With this in mind, it is crucial that the law remain in effect because it will limit out-of-pocket and annual health care costs.

The ACA also regulates the cumulative cost of lifetime spending on medical needs.”Insurers must also cap annual out-of-pocket expenses at $6,050 for individuals and $12,100 for families.” (Kliff, Wonkblog).

If health insurance companies want to continue to operate, they apparently need to comply with health reform’s essential benefits. The Affordable Care Act was designed to offer more options to more people when it comes to health care coverage, and the companies that provide policies need to get on board with the act, or watch their business crumble.


About B. Somers

B. Somers is a contributor to Health Insurance News, focusing on medical coverage, carriers, health reform and the conflicts surrounding insurance. Writing for the company's sites has provided a strong introduction to health insurance, and the opportunity to gain knowledge in the insurance industry.