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HHS Says No Marketplace Qualified Plan Comparable to CHIP

In a recent report, the Secretary of Health and Human Services (HHS) said it cannot certify that any qualified health plans (QHPs) offered in health insurance marketplaces (exchanges) provide coverage comparable to the Children’s Health Insurance Program (CHIP).

The Affordable Care Act, which created the marketplaces, required HHS to compare benefits and cost-sharing in QHPs to CHIP coverage. In a Nov. 25 report on this comparison, HHS found that average out-of-pocket spending was higher in QHPs than in CHIP, even when accounting for QHP coverage with financial assistance. As such, families are expected to pay a larger percentage of expected covered health care costs with QHP coverage than CHIP in every state.

HHS also found that benefit packages in CHIP generally are more comprehensive for child-specific services, as well as for children with special health care needs. But core benefits, including physician services, laboratory, and radiology services, are comparable in CHIP and QHP coverage.

Contact Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Matt Buechner is the policy and advocacy associate for America's Essential Hospitals.