With more parts of the Affordable Care Act going into effect over the coming months, the new changes will give consumers a reliable method to compare and enroll in healthcare coverage in the small group and individual markets, while giving insurance companies and states more independence and versatility to enforce the new law.

The U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius commented:

“The Affordable Care Act helps people get the health insurance they need. People all across the country will soon find it easier to compare and enroll in health plans with better coverage, greater quality and new benefits.”

The new report touches upon health insurance issuer standards for a principal package of benefits. The bodies that issue health insurance are now required to cover inside and outside the Health Insurance Marketplace.

This final rule expands coverage of substance abuse and mental health disorder services, such as behavioral health treatment for millions of Americans.

A separate report also recently released, outlines how these particular plans will expand substance use and mental health disorder benefits as well as federal parity protections for over 62 million Americans.

Historically, close to 20 percent of people buying insurance were unable to have mental health coverage and almost one third had no access to substance use disorder services.

The current rule aims to fill the gap in coverage in the following three ways:

  • Essential Health Benefits now include mental health and substance use disorder benefits.
  • Federal parity protections will be given to mental health and substance use disorder benefits in the small group and individual markets.
  • Americans will be given wider access to quality healthcare that includes substance use and mental health coverage disorder services.

The rule also establishes a benchmark-based approach which allows states to select a benchmark plan from several choices being offered in the market, which are similar to a general employer plan.

This will help give the states flexibility to determine essential health benefits via a method that best meets the needs of their citizens. Out of the 50 states, 26 have chosen a benchmark plan for their state – the largest small business plan will be the benchmark for the rest in each state.

Also identified in the rule are actuarial value levels in the small group and individual markets, helping differentiate between health plans that offer different levels of coverage.

Starting in 2014, plans that cover essential health benefits will be required to cover a specific percentage of costs, called “metal levels”. The levels are as follows:

  • 90 percent for a platinum plan
  • 80 percent for a gold plan
  • 70 percent for a silver plan
  • 60 percent for a bronze plan

Metal levels will let consumers compare insurance plans with similar rates of coverage and cost-sharing based on provider networks, premiums, and other factors. Additionally, the law controls the yearly amount of cost sharing that people will pay among all health plans – meaning that Americans will not be paying enormous amounts when dealing with an illness or injury.

The new rules will help buyers compare and choose health plans in the small group and individual markets based on what things are significant to them and their families.

People will be better equipped to make these decisions knowing the health plans they choose will cover a central set of essential benefits and can compare the level of coverage based on a consistent standard. Most notably, these changes also broaden the choices and competition throughout the marketplaces.

Written by Kelly Fitzgerald