The Affordable Care Act ensures health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, offer a comprehensive package of items and services, known as essential health benefits. Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace. States expanding their Medicaid programs must provide these benefits to people newly eligible for Medicaid. Essential health benefits must include items and services within at least the following 10 categories:
While you are a hospital patient, care from doctors, nurses, hospital staff, laboratory, test, medications are covered. Room and board are also covered.
Hospitalization coverage includes transplants, and surgeries.
Laboratory Services
Doctors use laboratory services to diagnose an illness, injury or condition.
They also use laboratory services to monitor the success of certain treatments.
Some preventive screenings are provided free of charge.
Emergency Services
These type of services include emergency visits to the hospital that can lead to serious disability or death.
These type of emergencies are usually accidents or sudden illness. Ambulance is included.
Out-of -network visits to the emergency room for these type of events cannot be penalized for not having prior authorization.
Mental Health Services
Inpatient and out-patient care provided to evaluate, diagnose, and treat a mental health condition or substance abuse disorder.
Rehabilitation Services
Rehabilitative services and devices that you gain recover skills from physical and mental injuries or chronic conditions.
Pediatric Care
Care for infants and children. Well-child visits and recommended vaccines/immunizations are included.
Dental and vision must be included for children that are younger than 19 years old.
Prescription Drugs
Medication a doctor prescribes to treat an illness or condition.
Preventative & Wellness Services
Preventive care, such as physicals and cancer screenings that help detect or prevent certain medical conditions.
Ambulatory Services
Care you receive without being admitted to a hospital, such as doctors’ visits or same day out-patient services.