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WCH News

February 18, 2014

 

Every medical provider is experiencing the effects of Obama Care: new plans, changes in benefits, new requirements and so much more. WCH explains some of the main changes that we see taking place.

The changes include a core set of comprehensive benefits, more cost sharing choices and new premiums for members of insurance plans.

BENEFITS ARE CHANGING

All health insurance policies will include a core set of benefits called “essential health benefits”

These are the 10 key health services that must be covered by every health plan:

1. Care at a doctor's office

2. Emergency services

3. Hospital care

4. Pregnant mother and baby care

5. Mental health and addiction treatment

6. Prescription drugs

7. Rehab and skill development services and devices

8. Lab services

9. Prevention & wellness services and long-lasting disease management

10. Dental and vision care for children

 

Cost Sharing Choices

The ACA creates four different health insurance policies which provides with cost sharing option choices.

The “Metal” levels are based on the average percentage of medical costs the health insurance company is expected to pay compared to the average percentage patients will pay.

The polices will fit into one of four metal levels:

  • Platinum - 90/10 %
  • Highest level with an average of 90% of the medical costs paid by insurance company and an average of 10% paid by the patient
  • Gold - 80/20%
  • Silver - 07/30%
  • Bronze - 60/40%

 

The premiums will be higher or lower depending on the metal the patient chooses. A silver plan will have lower premiums that a platinum plan because the patient would be paying more out of pocket.

 

 

 

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