HHS/ASPE. U. S. Department of Health and Human Services.Background


Essential Health Benefits:  Individual Market Coverage

December 16, 2011

This Issue Brief is available on the Internet at:

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[1]  EHBs apply to non-grandfathered plans in the individual and small group markets both inside and outside of the Exchanges, Medicaid benchmark and benchmark-equivalent, and Basic Health Programs.

[2]  Data were submitted by health insurance issuers in to HealthCare.gov in June 2011, including coverage of benefits in individual market plans and total enrollment in each individual market plan.  These plans cover about 4 million people – there are another 10 million people enrolled in plans that are not open or did not submit data to HealthCare.gov.  Data is only required to be submitted for plans currently accepting new enrollees that account for more than 1 percent of an issuer’s enrollment in a given zip code, and these numbers only reflect plans that were successfully presented on HealthCare.gov in June 2011.  If the benefits covered in these open plans are similar to those covered in closed or grandfathered plans, then these numbers can be extrapolated to the individual market.

[3]  The total number of individuals was calculated by multiplying the proportion of individuals without coverage from HealthCare.gov with America’s Health Insurance Plans estimate of 14 million enrollees in the individual market (See  http://www.ahip.org/Issues/Individual-Market-Health-Insurance.aspx).

[4]  These numbers do not include estimates of small group market enrollees whose coverage does not currently include these benefits.  Some small group market plans sell riders for benefits such as maternity, mental health, substance abuse, and prescription drugs.  Individual companies can decide whether or not to purchase any available riders for these benefits.

How to Obtain a Printed Copy

To obtain a printed copy of this report, send the title and your mailing information to:

Health Policy, Room 447D
Assistant Secretary for Planning and Evaluation
U.S. Department of Health and Human Services
200 Independence Ave, SW
Washington, DC 20201

Fax:  (202) 690-2524
Email:  pic@hhs.gov

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U.S. Department of Health and Human Services (HHS)

Last updated:  12/16/11