All private health insurance plans available in the marketplace must include these ten essential health benefits irrespective of plan category and type. (Remember that these are the basic requirements for all health insurance programs. Specific services covered in each general benefit category may vary depending on your state’s requirements.)
Covered essential healthcare benefits
- Emergency services
- Ambulatory patient care
- Hospitalization
- Pregnancy, maternity, and infant care services (pre and post-birth)
- Mental health and addiction disorder services
- Prescription medications
- Pediatric services, such as vision and oral (dental) care
- Preventive & healthcare services and chronic disease management
- Laboratory facilities
- Rehabilitative and habilitative equipment and services
Additional services may be available to you
- Breastfeeding and birth control are both covered under marketplace plans.
- Your program may also include vision and dental coverage, as well as medical management programs (for consumer-specific needs like weight management, diabetes, and back pain).
Check to see what else your marketplace health insurance plan covers.
