How many health plans are "substandard"? 98 percent.
....How many plans are “substandard”? Nearly all of them.
Millions of Americans are being told their plans are “lousy” or “crummy” because they are indeed, in a hyper-literal sense of the word, “substandard.”
Meaning they fail to meet the new standard for so-called Essential Health Benefits required of all plans in the individual and small-group markets when they lose grandfather status. This is the "standard," in brief:
This “standard” excluded nearly every plan in the individual market.
According to HealthPocket: “The data shows that there will be a near complete transformation of the individual and family health insurance market starting in 2014. Less than 2% of the existing health plans in the individual market today provide all the Essential Health Benefits required under the Affordable Care Act (ACA).”
Even the best of the best plans are being canceled in the individual market. Bob Laszewski, a top industry analyst, described his cancelation:
“I have been in this business for 40 years. I know junk health insurance when I see it and I know ‘Cadillac’ health insurance when I see it. Right now I have ‘Cadillac’ health insurance… The new plan would have a deductible $500 higher than the one I now have and a lot more if I go "out-of-network" inside the rest of the Blue Cross national network… And, wait all you people telling me rate shock does not exist, the new far more restricted plan costs 66% more than our current monthly premium.”
....Maternity & Pediatric Care Especially Lacking from Existing Plans
...On average, the health plans provided 76% of the ACA’s Essential Health Benefits.3 Benefits such as hospitalization, emergency care, and ambulatory services (such as visits to a primary care doctor or specialist) were covered by almost all plans in one form or another. A more detailed analysis of our results revealed that the missing 24% of Essential Health Benefits were concentrated around a few categories.
Dental and vision care for children was the least likely of the Essential Health Benefits to be provided in base benefits for a health insurance plan. Only one out of four plans nationally had these benefits within their base coverage. Looking at these benefits at a more granular level revealed that only 8% of plans provided coverage for dental check-up services. Maternity coverage was nearly as infrequent as pediatric dental and vision coverage. Two thirds of health plans did not offer their beneficiaries prenatal, delivery, and postnatal healthcare coverage. Substance Use Disorder Coverage was frequently absent in health insurance coverage as well. Only half of plans covered inpatient and outpatient services for substance use issues (e.g. alcohol or drug addiction). Mental health coverage was slightly better with six out of ten plans covering inpatient and outpatient treatment.