10 Essential Health Benefits Covered in the Marketplace

In the article “10 Essential Health Benefits Covered in the Marketplace,” you will discover the comprehensive coverage provided by all private health insurance plans offered in the Health Insurance Marketplace®. As mandated by law, these plans must cover the same essential health benefits, which include ambulatory patient services, emergency services, hospitalization, pregnancy and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services, chronic disease management, and pediatric services. In addition to these essential benefits, plans also include coverage for birth control and breastfeeding. Some plans may even offer dental and vision coverage. Please note that specific services may vary depending on your state’s requirements. To learn more about what these plans cover, continue reading the article.

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Ambulatory patient services

Ambulatory patient services refer to outpatient care that individuals receive without being admitted to a hospital. These services are an essential benefit covered by all Marketplace health insurance plans. Examples of ambulatory patient services include doctor’s visits, outpatient surgeries, laboratory tests, diagnostic imaging, and preventive screenings. By covering ambulatory patient services, Marketplace plans ensure that individuals have access to necessary medical care while avoiding the high costs associated with hospitalization.

Emergency services

Another essential benefit covered by all Marketplace health insurance plans is emergency services. In the event of a medical emergency, individuals can seek immediate care without worrying about the financial burden. These services include emergency room visits, ambulance transportation, and urgent care visits. By covering emergency services, Marketplace plans ensure that individuals can receive timely and life-saving treatments without delays or financial barriers.

Hospitalization

Hospitalization is a crucial aspect of healthcare coverage and is included as an essential benefit in all Marketplace health insurance plans. If you require admission to a hospital for surgeries, specialized treatments, or medical conditions that require intensive care and overnight stays, your Marketplace plan will cover the costs associated with hospitalization. This coverage provides individuals with the assurance that they can receive the necessary inpatient care without incurring substantial financial burdens.

Pregnancy and newborn care

Marketplace health insurance plans also include coverage for pregnancy and newborn care. This comprehensive coverage includes both prenatal and postnatal care, as well as the delivery of the baby. It also encompasses services such as ultrasound screenings, prenatal vitamins, gestational diabetes care, and lactation support. By providing coverage for pregnancy and newborn care, Marketplace plans prioritize the health and well-being of expectant mothers and their babies.

Mental health and substance use disorder services

Mental health and substance use disorder services are essential benefits that are covered by all Marketplace health insurance plans. This coverage includes behavioral health treatment, counseling, psychotherapy, and medication management for mental illnesses and substance use disorders. By ensuring coverage for these services, Marketplace plans support individuals in accessing the necessary care to address their mental health and substance use needs. This coverage fosters comprehensive and holistic healthcare for individuals, emphasizing the importance of mental well-being in overall health.

Prescription drugs

Marketplace health insurance plans also cover prescription drugs as an essential benefit. This coverage ensures that individuals have access to necessary medications prescribed by their healthcare providers. Whether it is a short-term prescription or a long-term chronic medication, Marketplace plans provide coverage for a wide range of prescription drugs. By including this benefit, individuals can afford their medications and manage their health conditions effectively.

Rehabilitative and habilitative services and devices

Rehabilitative and habilitative services and devices are another essential benefit provided by Marketplace health insurance plans. Rehabilitative services aim to help individuals recover from injuries, surgeries, or disabilities, while habilitative services focus on the development and improvement of skills and abilities in individuals with developmental or cognitive impairments. These services include physical therapy, occupational therapy, speech therapy, and assistive devices such as prosthetics or hearing aids. By covering rehabilitative and habilitative services and devices, Marketplace plans support individuals in achieving optimal functioning and independence.

Laboratory services

Laboratory services are an essential benefit covered by all Marketplace health insurance plans. These services include diagnostic and screening tests conducted in a laboratory, such as blood tests, urine tests, genetic testing, and pathology services. By covering laboratory services, Marketplace plans ensure that individuals can receive accurate and timely diagnoses, enabling effective treatment and disease management.

Preventive and wellness services and chronic disease management

Preventive and wellness services, as well as chronic disease management, are essential benefits provided by all Marketplace health insurance plans. These services aim to promote good health, prevent disease, and manage existing health conditions effectively. Preventive services include immunizations, cancer screenings, well-woman exams, and routine check-ups. Chronic disease management encompasses regular consultations, prescription medications, and lifestyle interventions for individuals with conditions such as diabetes, hypertension, or asthma. By covering preventive and wellness services and chronic disease management, Marketplace plans prioritize preventive care and help individuals maintain optimal health.

Additional information on Marketplace health insurance plans coverage

In addition to the ten essential benefits outlined above, Marketplace health insurance plans may offer additional coverage for specific services like dental and vision care. Some plans include coverage for birth control and breastfeeding services. The availability of these additional benefits may vary depending on the state and specific plan. It is important to review the details of the Marketplace health insurance plans available in your area to understand the specific coverage options and benefits provided.

For more information on the coverage provided by Marketplace health insurance plans, individuals can visit the official Health Insurance Marketplace website or consult with a licensed insurance broker or agent. Understanding the extent of coverage and benefits can help individuals make informed decisions when selecting a health insurance plan that best suits their needs. By leveraging the comprehensive coverage provided by Marketplace plans, individuals can access the necessary healthcare services and treatments without significant financial burden and ensure their overall well-being.

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Source: https://www.healthcare.gov/blog/10-covered-marketplace-health-benefits