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Essential Health Benefits

8-Ball SaysYesterday I received a phone call from a concerned office manager: “So, is Obamacare going to cover chiropractic or not?”

Very few of you would be surprised to hear me say that this answer isn’t going to be straight-forward. However, if you were simply asking my predictions I’d say it looks good, and here’s why:

Illinois needs to pick its benchmark for our essential health benefits package under the Patient Protection and Affordable Care Act this month.  Sound confusing?  It’s actually not so bad.

A “benchmark” plan is a sort of baseline chosen to represent a typical insurance plan in our State. Under the Affordable Care Act (“Obamacare”) the federal government had identified 10 of our largest insurance plans and told us to pick one.   Some examples are:

  • United Healthcare Choice Plus
  • BCBS BlueAdvantage
  • BCBS BlueEdge
  • Health Alliance HMO

Once a benchmark plan is selected and approved by the federal government, it represents a minimum level of coverage for small group and individual plans within the state. Now just because a particular service is included by the benchmark, that does not mean that all insurance plans must also cover that service, but if they remove it they must replace it with something of equal actuarial value.  However, since most of these private and small group plans currently include a form of chiropractic adjustment coverage, I believe that most would maintain it after the Affordable Care Act takes place.

Beyond having chiropractic adjustments covered by the benchmark plan, there are a number of other concerns we have regarding the structure of the plans and essential health benefits. The Illinois Chiropractic Society has already had numerous conversations with the State on this matter and we have submitted our formal comments as well to the council.

As always, please feel free to email me if you have any questions at rob@ilchiro.org.

Categories: Uncategorized
  1. September 18, 2012 at 1:58 pm

    Thanks for keeping us up to date Rob.

  2. September 18, 2012 at 3:29 pm

    Thanks Rob. Always great to get good news!

  3. September 19, 2012 at 7:55 am

    Do essential benefits have to be determined by end of September?

    • September 19, 2012 at 10:19 am

      Illinois has to make it’s recommendations to the federal level by the end of September. I would imagine that DHS will accept our recommendations, but this is all brand new territory with no good precedent.

      In short, I’d say “yes” but it won’t be official until it’s approved in Washington.

  4. john longinotti
    September 28, 2012 at 3:38 pm

    The state has decided on blue advantage small group as the benchmark. Is this an HMO,PPO or POS?

  5. john longinotti
    September 28, 2012 at 4:08 pm

    As a follow up to my last question, is the BC/BS plan for Illinois the blue advantage entrepreneur PPO as outlined by the fed recommendations for the 3 largest, small group products?

  6. October 1, 2012 at 3:26 pm

    Dr. Loninotti,
    Yes, the BCBS BlueAdvantage would have been the default plan picked by the federal government in the event Illinois did not choose one for itself. It is the largest small group plan in the state by enrollment. It is my understanding that the UnitedHealthcare Choice Plus Plan was one of the other major plans under serious consideration.

    Sorry I didn’t get back sooner, but I was out of the state.

  7. john longinotti
    October 1, 2012 at 3:55 pm

    Rob, Thanks. I think the Blue Advantage Entrepreneur is a good choice for chiropractors. Hopefully, it will give us a chance to treat a higher per centage of the population, even if it is only in IL.

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