Do private insurers have to offer all of the same services as listed in the coverage part of the law? The law/act seems to be focused on medicare?


All private insurance that qualifies as Major Medical coverage must offer the cost sharing and benefits of a bronze plan. This means they must include services of ten categories of essential benefits (mostly at the plans cost sharing amount). This rule doesn't apply for firms with 50 or more full-time equivalent employees.

You are right, the law itself is focused on bringing down the rising cost of Medicare spending. It's working well actually, growth in spending is the lowest it has been in a long time.

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E. Bayles on

what I have been trying to find out for weeks is if my retiree insurance through a state interface with the protections Obamacare offers Americans? Or are we grandfathered in with the policy we had? The policy changed in that now Medicare is primary and they are secondary however it is far from what was promised to us and it will go to court like the last time, but it will be about 10 years and I may be gone by then.

Please advise on

Very specific plans (short term, limited benefit, in theory large employer and Union) and plans that haven’t changed since before the ACA started, and Medicare, don’t have to offer the same exact standards as plans sold on the private market for individuals and families (for example, plans sold on HealthCare.Gov).

With that said, almost all the above types offer at least those standards or better aside from short term and limited benefit (for example limited benefit Medicaid).

So in practice that means, if a plan you are on is not offering you services you would typically find with at least Original Medicare or a marketplace plan, there could be some sort of recourse for you. Maybe you are being short changed, maybe the answer is move to another plan. I don’t know enough specifics about your situation, but if something doesn’t seem right, say something and get to the bottom of it.

Hope that gives a little insight. I really can’t say more without knowing more.