DC and Maryland Regulations Regarding the ACA-mandated Tobacco Coverage Services

In 2011, The DC City Council established the DC Health Benefit Exchange, and later in 2013, announced it marketplace: DC Health Link. Under the DC Health Link program, all private health plans must provide a variety of essential health benefits, the following of which pertain to tobacco cessation services: doctor visits, hospital stays, prescription drugs, preventive services and tests, rehabilitative services, chronic disease management, mental health care, and substance use disorder services. The 4 major insurance companies participating in DC Health Link, Aetna, CareFirst BlueCross BlueShield, Kaiser Permanente, and United HealthCare, offer over 260 small group plans and over 30 individual and family plans. The DC Health Benefit Exchange Authority board bans the tobacco surcharge, requiring all insurers to sell coverage to tobacco users at the same rates as non-users.[i] More information about the DC Health Benefit Exchange can be found at http://hbx.dc.gov/, and information on DC Health Link can be found at https://dchealthlink.com/.

  The Maryland Health Connection is the state’s health insurance marketplace that opened on October 1, 2013 for individual consumers, and on April 1, 2014 for small businesses. So far, 163,856 Maryland residents have created accounts and signed up on the Maryland Health Connection website, as reported on February 15, 2014.[ii] The marketplace hopes to make healthcare coverage accessible to all Maryland residents, and particularly reach the approximately 800,000 (14%) Maryland  residents who previously did not health coverage. As of February 18, 2014, an additional 60,672 Marylanders are newly enrolled in Medicaid.[iii]The marketplace features a variety of health plans offered by four insurance companies and seven Managed Care Organizations (MCOs) for Medicaid. Consumers can shop and compare plans at MarylandHealthConnection.gov. In addition, 95,889 persons enrolled under the Maryland Primary Adult Care Program (PAC), which provides pharmacy and basic health coverage for persons who are not Medicare beneficiaries and are not eligible for full Medicaid benefits, have been automatically switched over to receive full Medicaid benefits via the marketplace since January 1, 2014.[iv] All plans are required to provide some degree of coverage for medical services including, but not limited to: doctor visits, hospitalization, prescriptions, medical tests, mental health care, substance abuse treatment, etc. All plans must cover preventive care at no extra cost to the consumer, which includes screenings for cancer. However, the state of Maryland does support the tobacco surcharge, allowing insurers through MD Health Connection to charge up to 50% more on premiums for their tobacco using clients.[v] Only state employees are exempt from the tobacco surcharge, as reported by the American Lung Association.[vi] More information about Maryland Health Connection can be found at http://marylandhealthconnection.gov/.