Acupuncture will be included in all Maryland and California small group and individual health insurance plans beginning in 2014. The Patient Protection and Affordable Care Act, also known as Obamacare, outlines ten essential health benefits and it is up to individual states to decide the details for their citizens. The essential health benefits are: ambulatory services, emergency care, hospitalization, maternity and newborn care, mental health and substance abuse care, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventative and wellness care and chronic disease management, pediatric care.
Maryland’s Lt. Governor Anthony G. Brown recently presided over the Maryland Health Care Reform Coordinating Council in Annapolis. The council, charged with defining essential health benefits, chose from amoung ten existing insurance plans already available in the State of Maryland. The benchmark plan chosen was one already provided to state workers. The plan includes acupuncture for pain management as part of the preventative and wellness care essential health benefit.
Governor Jerry Brown of California recently signed healthcare legislation authored by Assemblymember Bill Monning (D-Carmel). The new laws sets baseline benchmarks for essential health benefits to an existing Kaiser Permanente health insurance plan. The Kaiser plan includes acupuncture for the treatment of pain and nausea. Under the new federal law, medical treatment limitations can be no greater than those adopted by the state. As a result, there is no cap on the annual number of acupuncture treatments allowed to patients because the Kaiser plan does not include this limitation. However, it is left to health insurance companies to decide copays, deductibles, referral requirements and physician networks. Some federal restrictions apply to cost sharing and actuarial value. These restrictions are intended to make health insurance plans more affordable.