Under the health-care law, plans sold on the individual market — to consumers who don't get insurance through their jobs and must buy their own policies — are required to provide a minimum package of benefits, including maternity and newborn care.
Some current plans don't meet the standard and thus are being discontinued. As a result, some consumers will be required to switch plans and perhaps pay higher premiums. Here are the details:
1. What exactly is happening?
Starting Jan. 1, individual policies must provide benefits — including prescription drugs, mental-health treatment and inpatient hospital care — similar to those offered by employer plans. Consumers whose plans don't meet the standards are being notified that they need to switch to different plans. Insurers are offering alternative policies designed to comply with the law. Consumers may also shop for coverage on state or federal exchanges, where they can find out whether they qualify for subsidies to help reduce their costs.
2. Who is affected by the insurance cancellations?
A subset of people on the individual insurance market, which covers about 12 million people, or about 5 percent of the population.
3. I'm a 58-year-old man. Why do I have to buy a plan that covers maternity care?
One goal of the health law is to ensure that plans on the individual market offer a minimum package of benefits — a kind of floor — and that sick people aren't charged more. In employer plans, everybody pays the same premiums, even though some workers make much greater use of health services than others.
The administration wanted to spread the medical costs for people in individual plans across as big a group as possible — in effect, to pool policyholders the way that big companies pool their own employees. The healthy people subsidize the sick people.
4. Are there any benefits just for men?
Yes. Among the preventive services that must be covered is one designed to screen older men who have been smokers for abdominal aortic aneurysms. Aneurysms can break open and cause bleeding and death.
5. Why was maternity care included?
Many policies on the individual market have not covered maternity care as a standard benefit. That came as a surprise to some women who became pregnant. Many found that if they tried to switch to another insurer, the new carrier would treat the pregnancy as a preexisting condition and not cover the cost.
Navigating Obamacare: Your guide to the Affordable Care Act