State Coverage: Essential Health Benefits and Underinsurance

The project team will analyze health plan documents from issuers in 15 states who sold marketplace products in 2014 and 2015. The plan documents are from issuers selling plans in a range of geographic regions, health care markets, and marketplace types. The aim of the review is to examine whether there are coverage limitations in EHB-compliant plans that particularly affect women and identify those health care services for which issuers are most likely to offer limited or no coverage. This analysis will provide insights into whether and how issuers and current regulation may still be leaving consumers, with a focus on women and their families, underinsured. This project will help identify weaknesses in the current EHB regulation and inform efforts to improve consumer protections against the financial and health-related consequences of underinsurance. The study findings will provide policymakers and consumer health organizations with an evidence base on current plan designs and help inform policy adjustments at the state and federal levels.