Essential Health Benefits: 50-State Variations on a Theme

Researchers find significant state variation in the essential health benefit packages (EHBs) that insurance companies are required to cover if they offer plans in the marketplaces created by the Affordable Care Act (ACA).

The Issue

This study illustrates that outside of the 10 ACA-mandated service categories, where patients live determines whether they’ll have coverage for the care they need.

The majority of data used in this study was collected from the CMS Revised Benchmark Benefits Worksheet published May 22, 2014. This data set contained a collection of state-specific worksheets detailing essential health benefits, state required benefits, quantitative limits on benefits and other general coverage information for all 50 states and the District of Columbia.

Key Findings

  • 25 states require plans to cover nutrition counseling

  • 26 states require coverage of services to treat autism

  • 45 states require coverage of chiropractic care

  • But only 5 require coverage for weight loss programs

Conclusion

The government will reassess whether or not to set a national benchmark EHB plan in 2016, but until then, the range and scope of services included in the EHBs will vary greatly from state to state.

 

About the Grantee

The Leonard Davis Institute of Health Economics (LDI) is the University of Pennsylvania’s center for research, policy analysis, and education on the medical, economic, and social issues that influence how health care is organized, financed, managed, and delivered.

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