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GAO-20-634R 1 (2020-08-24)

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GAO U.S. GOVERNMENT ACCOUNTABILITY OFFICE
441 G St. N.W.
Washington, DC 20548


August 24, 2020


The Honorable Robert P. Casey, Jr.
Ranking Member
Special Committee on Aging
United States Senate

The Honorable Debbie Stabenow
United States Senate



Private Health Coverage: Results of Covert Testing for Selected Offerings

Millions of Americans obtain health insurance coverage in the individual market, which consists
mainly of private plans sold directly to consumers without access to group coverage. While
generally regulated by states, starting in 2014, the Patient Protection and Affordable Care Act
(PPACA) established a number of new federal requirements for individual health insurance
coverage. For example, PPACA prohibited insurers from excluding coverage or charging higher
premiums for pre-existing conditions and required that individual market plans cover a set of
essential health benefits, including coverage for mental health and substance abuse disorder
services, prescription drugs, and maternity and newborn care.1
Certain types of health coverage arrangements that can be sold directly to consumers do not
have to comply with some or all of PPACA's individual market requirements and, as a result,
may be less expensive, but also offer more limited benefits compared to PPACA-compliant
plans. For example, short-term, limited-duration insurance (STLDI), which was primarily
designed to fill gaps in coverage, is excluded from the definition of individual health insurance
under federal law and is therefore generally not subject to PPACA's requirements for the
individual market.

















1Pub. L. No. 111-148, §§ 1201,1302,124 Stat. 119, 154, 163 (2010).


GAO-20-634R


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