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A new look at ACA-compliant non-group coverage

Health Care and Health Insurance
by David Dillon
Vast majority of Americans still struggle with basic health insurance terms
Vast majority of Americans still struggle with basic health insurance terms

One of the big concerns about the Patient Protection and Affordable Care Act in recent years has been related to the ways in which the law sets minimum requirements for the benefits of health insurance policies. But at this point, the vast majority of coverage options do meet those standards, with only a few that were initially grandfathered into the system still lingering. As a result, where and how people buy their plans is changing rapidly.

Today, nearly 2 in every 3 non-group health insurance plans were purchased on the ACA's mandated exchange websites, according to new data from the Kaiser Family Foundation, as part of an ongoing look at how these plans are changing the health insurance landscape. The second-largest group breakdown in this regard - at slightly fewer than 1 in 5 - is plans bought privately, usually directly from an insurance company or through a broker, which comply with the ACA's standards.

A variety of ACA-compliant coverage options now exist, but what's the impact?A variety of ACA-compliant coverage options now exist, but what's the impact?

Other respondents a mixed bag
Another 12 percent have non-group plans that do not comply with the ACA standards, but which were often purchased prior to 2010, the cutoff for the grandfathering of non-compliant plans, or October 2013, the cutoff for which states were given discretionary ability to more slowly shift pre-existing plans into ACA compliance, the report said. Another 4 percent weren't sure one way or the other whether their coverage was ACA-compliant, and 2 percent knew it is compliant but didn't know where they bought it.

Interestingly, 4 in 5 respondents who had ACA-compliant non-group plans said they would rate their health good, very good, or excellent, the report said. That's down from 85 percent in last year's survey, and 82 percent in 2014. That left another 20 percent who felt their health was merely fair or poor.

Further, those with ACA-compliant policies who only purchased on the exchanges were in more or less the same boat, with 78 percent saying their health was between good and excellent, and 22 percent saying it was less than that. That also represented declines in positive responses from 85 percent last year, and 79 percent the year before.

Who's buying?
And when it comes to who is purchasing these kinds of non-group plans, it should come as no surprise that nearly 3 in 5 said they did so because they were either self-employed (31 percent, the biggest subset in this group) or out of a job (28 percent), the report said. Another 21 percent of these buyers said their employers don't offer health insurance, and 18 percent more said their companies do offer, but they prefer to buy privately. Finally, 2 percent either weren't sure or refused to answer the question.

The fact is, though, that these consumers, and either the brokers or companies working with them to find compliant coverage may need to be more vigilant about the choices being made. Finding plans that work not only for their financial needs, but those of their health as well, should be of the utmost importance.

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