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Health Aff (Millwood). 2012 Jun;31(6):1339-48. doi: 10.1377/hlthaff.2011.1082. Epub 2012 May 23.

More than half of individual health plans offer coverage that falls short of what can be sold through exchanges as of 2014.

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  • 1Health Care Research Department at NORC at the University of Chicago, in Bethesda, Maryland, USA. Gabel-Jon@norc.org

Abstract

The Affordable Care Act creates state-based health exchanges that will begin acting as a market place for health insurance plans and consumers in 2014. This paper compares the financial protection offered by today's group and individual plans with the standards that will apply to insurance sold in state-based exchanges. Some states may apply these standards to all health insurance sold within the state. More than half of Americans who had individual insurance in 2010 were enrolled in plans that would not qualify as providing essential coverage under the rules of the exchanges in 2014. These people were enrolled in plans with an actuarial value below 60 percent, which means that the plans covered less than that proportion of the enrollees' health expenses. Many of today's individual health plans are below the "bronze" level, the lowest level of plan that can be sold through exchanges. In contrast, most group plans in 2010 had an actuarial benefit of 80-89 percent and would qualify as highly rated "gold" plans in the exchanges. To sell to ten million new buyers on the exchanges, insurers will need to redesign benefit packages. Combined with a ban on medical underwriting, the individual insurance market in a post-health reform world will sharply contrast with the market of past decades.

PMID:
22623614
[PubMed - indexed for MEDLINE]
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