Milestone: Assess the benefit packages in the state's public and private insurance programs to determine the current state of the market
Since benefit design can have a significant impact on access to care and utilization of health services, it is important for states to understand benefit packages in the existing insurance market before designing policies to incorporate ACA-related changes.
*Milestone details:
*Full name: Assess the benefit packages found in the state’s large group, small group, and individual markets, state employee health plan, and Medicaid and CHIP programs to determine the current state of the market.
*Relevance to the ACA:
In order to analyze the impact of ACA benefit requirements and options on their insurance markets, states must first understand the existing market. The ACA does not require states to conduct this assessment. Relevant provisions of the ACA include:
§1001 – Eliminates lifetime and annual limits; prohibits cost-sharing for certain preventive services; extends dependent coverage to age 26.
§1251 – Allows existing insurance plans to continue operating under “grandfather” status.
§1302 – The Secretary of Labor will conduct a survey of employer-sponsored insurance plans to determine what benefits are typically covered.
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Massachusetts
A toolkit published by the Blue Cross Blue Shield of Massachusetts entitled "Determining Health Benefit Designs to be Offered on a Health Insurance Exchange" provides resources helpful to other states in developing benefit packages.
The toolkit is one in a series of five toolkits publised by the BCBSMA Foundation wtih funding support from the Robert Wood Johnson Foundation and developed in collaboration with the Massachusetts Health Insurance Connector Authority and the Massachusetts Office of Medicaid.
District of Columbia
Earlier this month, Massachusetts released a report on health care cost trends. The report also includes an over view of plan benefits in the state.