Individual plans miss reform-law targets: study

The majority of individual health plans in a representative sample for the year 2010 did not meet the standards and benefits required by the Patient Protection and Affordable Care Act, according to the findings of a new Health Affairs study.

Researchers used the Kaiser Family Foundation/Health Research and Educational Trust 2010 Employer Health Benefit Survey to examine group plans and sampled enrollment data in five states through interviews with marketing managers at insurance carriers for the individual plans.

“More than half of Americans who had individual insurance in 2010 were enrolled in plans that would not qualify as providing essential coverage under the rules of the exchanges in 2014,” the study noted. “These people were enrolled in plans with an actuarial value below 60%, which means that the plans covered less than that proportion of the enrollees' health expenses.”

The report also showed that 51% of individual plans they evaluated had an actuarial value of less than 60%, which is the bottom of the so-called bronze range that is one of four levels established by the Affordable Care Act. That bronze level has an actuarial value of between 60% and 69%. Group health plans, however, fared better. According to the study, the average actuarial value for group health insurance plans was 83%, which falls in the “gold” level.

HHS offered additional guidance to states about the state exchanges last week.