Health Care Reform and Health Insurance Coverage for Hearing Services

By Morgan, Theresa | Volta Voices, March/April 2014 | Go to article overview

Health Care Reform and Health Insurance Coverage for Hearing Services


Morgan, Theresa, Volta Voices


Key health care insurance reforms mandated by the Affordable Care Act (ACA), signed into law by President Obama on March 23, 2010, went into effect at the start of this year. These reforms enable individuals, including individuals who are deaf and hard of hearing, to compare and purchase state and federally regulated health insurance products which by law must meet a number of new requirements.

For example, issuers are no longer allowed to deny people with hearing loss or other pre-existing conditions coverage under most new health insurance plans; certified qualified health plans (QHPs) must cover a minimum benefits package (including an array of hearing services which vary by state); and coverage limits under these plans cannot include annual and lifetime monetary coverage caps on essential health benefits (EHBs).

On Tuesday, October 1, 2013, states and the U.S. Department of Health and Human Services (HHS) opened their health insurance exchanges, otherwise known as "marketplaces." The marketplaces exist online and, when operating as intended, provide one-stop shops at which individuals and small groups can compare and purchase health insurance plans. Issuers display the various plans they are offering and consumers should be able to see what benefits are covered and at what cost, and choose the right plan for their circumstances.

Although all states have the authority to run their own marketplace, over 30 states have elected or defaulted to a federally-run or "partnership" exchange in which HHS will have significant operational and legal responsibility over the state activity. Only 18 states will run their own exchange in 2014. In the first days and weeks of their debut, both HHS and state exchanges experienced significant technical difficulties, rendering the exchanges at least temporarily inaccessible.

To date, HHS is reporting that at least 2 million individuals have purchased private insurance through the federal exchange. States are reporting varied success with enrollment. Starting this year, non-exempt individuals must show consistent enrollment in health insurance coverage or pay a fine.

The ACA provides premium subsidies for individuals earning between 100 percent and 400 percent of the federal poverty level (FPL). These subsidies will vary in value depending on where the individual's income falls within these limits. For those earning between 100 percent-250 percent of the FPL, subsidies for deductibles and copayments will also be available.

Coverage purchased on the exchanges by individuals and small groups before the December 2013 deadlines became effective on January 1, 2014. For each successive month, the deadline is the 15th in order to have coverage effective by the first of the next month. It is important for consumers to note that issuers only have to guarantee coverage during the initial enrollment period; after that initial deadline is passed, only consumers who have qualifying life events (i.e., marriage or having a baby), are guaranteed issue until the next open enrollment period.

Essential Health Benefits, the Benchmark Plan Process and Hearing Health

The ACA requires that all non-grandfathered individual and small group health insurance plans, as well as Medicaid benchmark and benchmark-equivalent plans, cover essential health benefits (EHBs); most new small employer and individual plans must cover EHBs regardless of whether these plans are offered on an exchange.

By law, there are 10 categories of EHBs, including ambulatory patient services, emergency services, hospitalization, prescription drugs, rehabilitation and habilitation services and devices. chronic care management and other categories of benefits.

Neither the law nor the federal EHB regulations stipulate the specific benefits within each category that plans must cover. Instead, federal guidance to the states has directed state officials to select an existing typical small group plan to become that state's benchmark plan for health care reform. …

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