States require insurers to include a wide array of essential health benefits in their plans, making it challenging for insurers to sell plans across state lines, according to a new report from the Robert Wood Johnson Foundation.
Under the Affordable Care Act, insurers must include certain essential health benefits in all their plans sold on the health insurance exchanges. However, states are authorized to decide which benefits insurers must cover in addition to those core requirements.
That policy led to benefit packages that "varied considerably across states," the RWJF report said. For example, chiropractic care is the most frequently required benefit (45 states), while acupuncture is the least covered benefit (required in just 5 states). Of the states that do require chiropractic coverage, about half limit visits to no more than 19 each year.
The benefits also differ for certain services within conditions like obesity. Although only five states require insurers include coverage for weight loss programs, 25 states require plans to cover nutrition counseling.
Meanwhile, 23 states require bariatric surgery coverage, but just 12 states cover nutrition counseling. That's the case for Tennessee's Medicaid program, which covers bariatric surgery, but won't pay for a dietitian's counseling services. And a survey from HealthPocket last year found 90 percent of more than 11,000 health plans didn't include coverage for weight loss surgery, FierceHealthPayer previously reported.
Experts fear coverage variations will increase if more insurers start selling their products across state lines. Some worry that states will roll back certain mandated benefits or that low-risk consumers who need certain mandated benefits will be drawn to a particular state, causing an adverse selection effect.
To learn more:
- here's the RWJF report
- see the executive summary