Shopping for a cheap individual health insurance plan and dismayed by the premiums? Assuming you’re in good health, don’t smoke and aren’t pushing retirement age, the reason could be mandates. Those are the benefits and services insurance companies are required to cover or offer coverage for if they want to sell health insurance policies. These benefits and services can be mandated by state government, federal government or both.
While federal mandates such as COBRA and the Family and Medical Leave Act apply to everyone, mandates will vary at the state level. They can range from modest to comprehensive depending on where you live. Arizona, for example, is the only state that mandates athletic trainers, Georgia mandates telemedicine and Maine mandates breast reduction. What that means essentially, is that the cost of guaranteeing coverage for highly specialized medical service is built into everyone’s coverage. Currently Rhode Island holds the record with 70 mandates while Idaho has the fewest at 17.
Mandates come in three categories:
Provider mandates can extend beyond the usual services offered by a physician to cover chiropractic, podiatry, social workers, massage therapists, speech therapists and other non-traditional medical services.
Benefit mandates range from office visits to mammography, alcohol and drug abuse treatment, acupuncture, hair replacement, in vitro fertilization and contraception.
Population mandates apply to the people to whom coverage must be extended (for a additional cost) under the terms of an individual or group policy. These typically can include newborns, adopted children, dependent students, grandchildren and domestic partners.
Proponents of mandates claim that without them health care costs and health insurance premiums would actually increase. This is based on the theory that if someone doesn’t get care for a medical problem because it isn’t covered by his insurance, his problem could get worse and require even more expensive care in the future.
Opponents of mandates point out that, depending on the mandated benefit and how it is defined, mandates can impact the cost of monthly health insurance premiums with increases ranging from less than 1% to 5% or more.
Regardless of where you stand on the issue of mandates, rest assured they will continue to grow as legislators seek to please their constituencies. As of Q1/2010, there were 2,000 health insurance mandates and the eventual adoption of ObamaCare provisions will no doubt add to the volume.