Essential Health Benefits
What are essential benefits?
Under the Affordable Care Act (ACA), most health insurance plans are required to cover a set of core essential benefits, including rehabilitative and habilitative services and devices. This includes plans offered in state Health Insurance Marketplaces.
Rehabilitation refers to services, therapies, and devices that help a person regain skills or functioning that he/she has lost due to illness or injury. Habilitation refers to services, therapies, devices that help a person gain skills or functioning that he/she has never had. Habilitation is most often appropriate for people living with developmental disabilities or those who have sustained injuries in early childhood.
For individuals with disabilities, the inclusion of rehabilitation and habilitation services in the initial list of Essential Health Benefits was a great victory. Many people with disabilities rely on such services, and prior to health reform, many insurance policies did not cover them or severely limited the number of treatments allowed.
Under the ACA, the Department of Health and Human Services (HHS) was given the authority to further define the specifics of Essential Health Benefits. However, HHS instead proposed to define Essential Health Benefits using what is known as a "benchmark approach."
Under this approach, each state was given flexibility to select a benchmark plan from a list of ten designated plans to serve as the state's standard for Essential Health Benefits. HHS has since issued guidelines to states on selecting plans and determining benefits, but coverage for rehabilitation still remains up to the state.
The Reeve Foundation strongly believes in including habilitative and rehabilitative services and devices as part of Essential Health Benefits. We also support a strong federal definition for rehabilitation to provide the most robust coverage possible through private health insurance and the Health Insurance Marketplaces.
HHS will revisit the list of benefits and their definition in 2016, and the Reeve Foundation will work with HHS and partners in the disability community to advocate for even stronger habilitative and rehabilitative benefits.
Our information specialists are available to help answer any questions you may have on the Affordable Care Act or direct you to additional resources.