RealClear Health Article Explains EHB Loophole and How the HELP Copays Act Can Fix It


RealClear Health recently published an article by Peter J. Pitts titled Just How ‘Essential Are Your Health Benefits.’ The article explains that under the Patient Protection and Affordable Care Act (ACA) health plans are required to cover a set of 10 Essential Health Benefits (EHB), including prescription drugs. However, the author explains that some plans have defined certain categories of prescription drugs as “non-essential” health benefits. By defining specific prescription drugs as non-essential health benefits the plan is thereby permitted to exclude any cost-sharing from counting towards the patient’s deductible and annual out-of-pocket maximums. This definition of non-EHB is known as the “EHB loophole.” Fortunately, the article explains that if enacted the Help Ensure Lower Patient Copays Act (HELP Copays Act) will close this EHB loophole by clarifying that all prescription drugs qualify as an EHB and, therefore, plans are required to count cost-sharing towards the patient’s deductible and annual out-of-pocket maximums. The full article can be found here.

Last Updated on December 22, 2021 by Aimed Alliance


Comments are closed.