Between November 2022 and January 2023, more Americans than ever before have enrolled in health insurance through the Affordable Care Act (ACA). Within just that three-month span, more than 16.3 million Americans signed up for ACA coverage.
Primarily, the ACA benefits people who were previously uninsured or who have had difficulty obtaining insurance due to pre-existing conditions. This includes low-income individuals and families who qualify for subsidies to help pay for coverage. The ACA also expands Medicaid coverage to additional states.
Record ACA enrollment opens up a world of possibilities for health plans to improve healthcare outcomes across all populations, including those that are often underserved or underrepresented. With more people now covered by the ACA than ever, health plans have an unprecedented opportunity to make a lasting impact on public health by encouraging members to take advantage of available resources and helping them receive more timely and relevant care.
What health plans provide under the ACA
The ACA requires all health plans to cover 10 essential health benefits. These benefits are designed to ensure that individuals have access to a comprehensive range of healthcare services that are essential for their well-being. These benefits include services for emergencies, hospitalization, laboratory results, mental health and substance use disorders, outpatient care, pediatric care, maternity care, prescription drugs, preventive care, wellness and chronic disease management.
In addition to these 10 benefits, the ACA also mandates that all plans provide birth control coverage, with exceptions for plans sponsored by certain religious employers. Similarly, breastfeeding coverage is also mandatory under ACA regulations. However, it’s important to recognize that ACA coverage can vary a little bit between states; some states allow different amounts of covered visits, while others add dental and vision coverage.
In general, the ACA’s requirements ensure that individuals have access to the care they need to maintain their health and well-being, regardless of their financial situation. With the assurance of these essential health benefits, covered members can feel confident that they will have access to the care they need when they need it.
How health plans can build awareness of ACA benefits
Health plans can play a crucial role in helping members become aware of and make the most of their ACA coverage. One way they can do this is by providing clear and easy-to-understand information about the ACA benefits available to their members in each state.
This information can be provided through websites, apps, handbooks or even in one-on-one meetings with a customer service representative. The goal should always be to ensure that members have a good understanding of the services they are entitled to, and know all the ways they can access those services. This includes providing benefits information written in clear, plain language with as little healthcare jargon as possible.
Another way health plans can support members is by offering programs and resources that encourage the use of preventive care services. For example, health plans can provide incentives for members who schedule regular check-ups, participate in wellness programs or manage chronic conditions.
These kinds of initiatives can not only help members take advantage of their benefits, but also improve their overall well-being and build their trust in their health plans. By working closely with members to educate and support them in using their benefits, health plans can help ensure that individuals receive the care they need to stay as healthy as they can.
Digital tools can help members make the most of ACA benefits
Health plans can also use new digital tools, including mobile platforms, to make it easier for members to access information and resources related to their ACA benefits. For example, a health plan could use a digital platform that allows members to easily view and manage their coverage information, find a doctor in their network or schedule appointments.
Digital platforms can put vital health education resources in the palms of members’ hands, including articles and videos on topics like preventive care, wellness services and chronic disease management. Plans can also seek out tools that allow members to track and monitor their health status, such as a symptom tracker or medication reminder.
By providing members with these types of resources through their personal digital devices, health plans can help individuals make the most of their ACA benefits and improve their overall health and well-being.
The use of digital tools can also benefit members by providing their care management teams with valuable data that can inform more personalized engagement. For example, data on a member’s usage of preventive care services or their progress in managing a chronic condition can be used to tailor care management plans to the individual’s specific needs.
This can include providing additional educational resources, connecting members with support services or adjusting treatment plans as needed. Using the data generated by digital tools, care management teams can create more effective, member-centered engagement strategies that better support individuals in their journeys toward better health.
Helping members achieve their best health through the ACA
It’s clear that health plans have a significant role to play in building awareness of ACA benefits and helping members make the most of their coverage. When they strive to provide clear information, encourage preventive care and offer the right digital tools, health plans can help members stay informed, healthy and engaged in the care they need through the ACA to manage their health and well-being for years to come.
