MOUNTAIN VIEW, CA--(Marketwire - Mar 19, 2013) - Today eHealth, Inc. (
Since 2005, eHealth's Cost and Benefits report has tracked the percentage of plans surveyed that cover eight health benefits deemed to be comprehensive by eHealth, including: Laboratory and X-Ray; Emergency Services; Prescription Drugs; Chiropractic; Maternity; OB/GYN; Periodic Exams; and Well Baby care. The new report, 'The Cost of Comprehensive Health Benefits' looks at the cost of just those plans surveyed that cover all eight benefits: approximately 30,000 individual plans purchased across 32 states through eHealthInsurance.com with coverage active in February of 2012 (see Table 1).
In 2010, the Affordable Care Act (ACA) created a new list of ten Essential Health Benefits (EHBs) that all major medical health insurance plans must cover at an actuarial value of 60% or more in order to fulfill the federal mandate for health coverage, beginning in January of 2014. Those EHBs include: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. (source)
"These data provide valuable insight into the cost of health insurance plans as consumers prepare to enroll in the more comprehensive health plans that will become available with the Affordable Care Act," said eHealth Senior Vice President of Carrier Relations Robert Hurley. "Our report does not provide an 'apples to apples' comparison of plans that cover the essential health benefits established in the Affordable Care Act, but it does provide some interesting insight into the potential impact that new benefits standards could have on the cost of health insurance plans in the individual health insurance market."
Highlights from the addendum report include the following:
- Average Individual Premiums Increase: $279 - Monthly premiums for the individual plans surveyed were forty-seven percent (47%) higher when a plan covered all eight benefits tracked in eHealth's Cost and Benefits report ($279 vs. $190)
- Average Family Premiums Increase: $605 - Monthly premiums for the family plans surveyed were also forty-seven percent (47%) higher when a plan covered all of the benefits tracked in eHealth's Cost and Benefits report ($605 vs. $412)
- Average Individual Deductibles Decrease: $2,257 - Annual deductibles for individuals were twenty seven percent (27%) lower when a plan covered all of the benefits tracked in eHealth's Cost and Benefits report ($2,257 vs. $3,079)
- Average Family Deductibles Decrease: $3,422 - Annual deductibles for families were sixteen percent (16%) lower when a plan covered all of the benefits tracked in eHealth's Cost and Benefits report ($3,422 vs. $4,079)
The report also analyzed average monthly premiums for individual plans that cover all of the benefits eHealth tracks by age. Table 2 below shows the average premiums for all individual plans with comprehensive benefits by age-range.
Prices for Average Individual Health Plans with Comprehensive Health Benefits (Table 2)
|Age Group||Average Individual Plan |
|Average Individual |
The data presented in this report do not reflect the impact that new Essential Health Benefit (EHB) standards will have on plan prices, nor does the report take into account other factors that may impact the cost of health insurance in 2014. Not only do some of the benefits differ and overlap, but chiropractic care is not deemed to be an EHB by the ACA. There are also other important changes that go into effect next year that could impact plan prices, including the following:
1. The mandate to have health coverage - The requirement that all Americans -- including the youngest and healthiest among us -- purchase health insurance does not go into effect until 2014. Today, roughly forty percent (40%) of adults between the ages of 18 and 34 are uninsured, yet they make up less than a quarter (24%) of the total population, according to the Department of Health and Human Services (source). The individual mandate, requiring many people without employer-based coverage to buy health insurance on their own or face a tax penalty, could push more young, healthy, Americans into the risk pool, which may help to lower prices.
2. Annual coverage limits - Beginning in 2014, Qualified Health Plans cannot place annual dollar limits on the coverage of essential health benefits.
3. Guaranteed issue - This is a requirement of the Affordable Care Act stating that applications for individual and family health insurance plans can no longer be declined due to a pre-existing medical condition.
4. Community rating - The Affordable Care Act requires that health insurance plans can only vary rates -- what they charge for a plan -- based on the applicants age, where they live, family size, and tobacco use. Price increases relating to these factors are limited to a 3 to 1 ratio for non-tobacco users. Tobacco users may be charged up to fifty percent more (a 1.5 to 1 ratio).
Comparisons of average premium costs for plans with comprehensive health benefits in the report were derived from a sample of more than 30,000 individual major medical policies purchased through eHealthInsurance with coverage in effect in February 2012. In most of the states used in this analysis it is possible for applicants to be declined coverage for individual health insurance coverage based on an insurer's review of their medical history.
The full addendum report, titled the 'Cost of Comprehensive Health Benefits,' is available online through the eHealthInsurance Media Center. The larger 'Costs and Benefits of Individual and Family Health Insurance Plans' report, released in November 2012, is also available.
Additional Consumer Resources:
- Download or request a FREE printed copy of our book, Individual Health Insurance For Dummies, Health Care Reform Special Edition, produced in cooperation with For Dummies®, a branded imprint of Wiley, and co-authored by eHealthInsurance
- Follow eHealthInsurance's consumer blog, Get Smart - Get Covered
- Browse our answers to real-life health insurance questions on Yahoo Answers
- Follow eHealthInsurance on Facebook and Twitter
eHealth, Inc. (
For more health insurance news and information, visit the eHealthInsurance consumer blog: Get Smart - Get Covered.