Adding “essential health benefits” will require increased premiums!

In a recent article I mentioned that health insurance rates will likely be higher after Jan. 1, 2014 when a major component of the Affordable Care Act goes into effect.  One significant reason is because health insurance companies will be required to provide coverage regardless of a person’s pre-existing health conditions.   Treatment for certain health conditions can cost thousands of dollars per month for specialist’s fees and brand name prescription drugs.  Those exceptionally high claims affect monthly premium costs.

 When someone applies for an individual health plan during the remainder of 2013, they will still be required to answer health questions to be considered for health insurance.   The healthier one’s medical record is, the more inexpensive their cost would be.  Conversely, having high health-risk factors can cause applicants to be “rated” with higher premiums, receive an exclusion rider for their health condition, or even be declined for coverage.  After Jan.1, 2014, no one can be declined for even the most serious (or most expensive-to- treat) health conditions.

Another reason premiums will likely be more expensive is due to the healthcare reform requirement for all health plans to include 10 essential health benefits or EHB’s.  The following is a list of those mandatory health benefits:

1. ambulatory patient services

2. emergency services

3. hospitalization

4. maternity and newborn care

5. prescription drugs

6. habilitative and rehabilitative services and devices

7. laboratory services

8. mental health and substance abuse disorder services, including behavioral health treatment

9. pediatric services

10. preventive and wellness services and chronic disease management. 

Some of these benefits are already included in many major medical plans which were issued in the last few years, specifically a free annual preventive exam.

 Insured small group plans and individual major medical health plans that are not “grandfathered” are required to cover EHB’s starting in 2014.  This obligation applies to all plans whether they are sold within the state or federal health insurance exchanges or outside of the exchanges.  All non-grandfathered health plans that cover EHB’s must provide a cap (or maximum amount) for member out-of-pocket expenses (in-network) for essential health benefits beginning on Jan.1, 2014.

 If you are not currently covered by an individual major medical plan, and you are not working for an employer who offers group health insurance, you will likely face higher premiums after Jan, 2014, when the health insurance requirements go into effect.  Fees will be assessed on the uninsured with the help of the IRS for collection! 

Get a quote now from an independent licensed insurance agent, while the current lower 2013 rates are still available.  Call at: (512) 535-3556 for a fast, free quote.  We can help you find an affordable health plan which will best suit your particular situation and budget.  You won’t find a lower price for our inexpensive plans anywhere else in Texas!



About tcdiehl

I have been an independent insurance agent licensed in Texas since 2003. My focus is providing affordable insurance coverage through multiple reputable insurance providers for individuals, families, and small groups. I can also help with Medicare insurance needs. Allow me to connect you with the appropriate health, life, disability, long term care, and/or dental plan(s) based on your health, personal, and financial needs. Call me at (512) 535-3556, E-mail:
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