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Top 10 Healthcare Services Excluded Under Obamacare

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SOURCE HealthPocket

80% of Coverage Exclusions from Pre-Reform Top 10 Remain

SUNNYVALE, Calif., Feb. 26, 2014 /PRNewswire-USNewswire/ -- A study of the medical services most frequently excluded from coverage by Affordable Care Act plans found relatively little change as compared to the pre-reform market. The top 10 most commonly excluded medical services in Obamacare health insurance plans are:

  • Long-Term Care
  • Cosmetic Surgery
  • Adult Dental Services
  • Weight Loss Program
  • Acupuncture
  • Routine Foot Care
  • Infertility Treatment
  • Private Nursing
  • Adult Eye Exam
  • Weight Loss Surgery

80% of the medical services in the top 10 list had also been uncovered by pre-reform health plans in the individual market. Children's dental coverage and eyeglasses, both on the 2013 list of most frequently excluded medical services, are missing in the 2014 top 10 list due to Obamacare's requirement that pediatric dental and vision benefits be included within standardized health benefits. Obamacare's Essential Health Benefits mandate did increase the coverage of other services such as maternity care but these benefits were not so scarce they were included in the top list of excluded healthcare services in the pre-Obamacare market. Other services such as doctor visits, hospitalization, and emergency care already were covered by nearly all health plans in the pre-reform market and are included in all Obamacare health plans. 

Despite Obamacare's mandatory coverage of obesity screening and obesity counseling, both weight loss programs as well as weight loss surgeries remain absent from coverage in most new individual health plans. Given the prevalence of obesity and the cost of the excluded weight-related medical services, these exclusions may receive some of the greatest scrutiny from public and politicians alike.

"The Affordable Care Act has had a profound influence on individual and small group health plans but our investigation found its effect upon the most frequently excluded medical services less significant," said Kev Coleman, Head of Research & Data at HealthPocket, "Most of the medical services excluded from insurance coverage in the pre-obamacare market remain excluded under Obamacare though we observed some reductions in the occurrence of several exclusions."

The study results were based on explicit entries of excluded medical services within government records of health plans in the individual & family health insurance market. The full results of the study can be reviewed in the InfoStat "Top 10 Healthcare Services Excluded Under Obamacare" at HealthPocket.com.

HealthPocket.com is a free website that compares and ranks all health insurance plans available to an individual, family, or small business to allow consumers to make their best health plan decision and reduce their out of pocket costs. HealthPocket uses only objective data from government, non-profit, and private sources that carry no conditions that might restrict the site from serving as an unbiased resource. Learn more at www.HealthPocket.com.

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