You'll be glad to know that all the private health insurance plans offered in the Health Insurance Marketplace are required to provide coverage for the essential health benefits. These benefits are grouped into 10 categories of services that are covered by all the Marketplace plans. This means that you won't have to worry about missing out on necessary medical care and treatment as they are all included in your plan.
Ambulatory patient services are the medical treatments that can be provided on an outpatient basis without requiring admission to a hospital. This benefit includes the diagnosis, treatment, and management of diseases and illnesses. Outpatient care can be delivered in a variety of settings such as doctor's offices, clinics, and ambulatory surgical centers. Benefits of ambulatory patient services include, but are not limited to, convenience, reduced healthcare costs, and less exposure to hospital-acquired illnesses.
Emergency services are a crucial benefit that provides immediate medical attention to individuals with life-threatening conditions. It includes emergency medical transport services (such as ambulance and air transport), emergency department visits, and trauma care. Emergency services provide rapid treatment to patients who need it the most, regardless of their ability to pay.
Hospitalization benefit covers expenses related to stays in a hospital setting, which may include surgeries, diagnostic tests, medications, and other treatments. Inpatient care is provided when a patient's condition requires overnight hospitalization. The hospitalization benefit ensures that patients get the necessary medical services, equipment, and facilities for their treatment and recovery.
Pregnancy and newborn care benefit includes prenatal care, delivery, and postpartum care. This benefit provides essential medical services and support to expectant mothers to ensure a healthy pregnancy and childbirth. It also covers the necessary medical services and care for newborns after birth, including well-baby checkups and vaccinations.
Mental health and substance use disorder services are benefits that cover treatment for mental health conditions and substance abuse. This benefit includes a range of services such as behavioral health treatment, counseling, and psychotherapy. Mental health and substance abuse are critical issues that require proper treatment and care. This benefit ensures that patients receive the necessary medical care and support to achieve optimal mental health.
Prescription drugs benefit covers the cost of prescription medications that are necessary for the treatment of acute or chronic conditions. This benefit ensures that patients receive access to the medications they need without financial barriers.
Rehabilitative and habilitative services and devices benefit includes physical therapy, occupational therapy, speech-language pathology, and devices such as prosthetics, braces, and crutches. It helps patients recover and regain their functional abilities after an illness, injury, or surgery.
Laboratory services benefit covers the cost of diagnostic medical laboratory tests. This includes tests such as blood tests, urine tests, DNA testing, and other diagnostic tests. Laboratory services play an essential role in diagnosing and treating various medical conditions accurately.
Preventive and wellness services and chronic disease management benefit includes routine checkups, screening tests, immunizations, and counseling to promote healthy lifestyles. This benefit helps patients maintain good health and detect diseases at an early stage for effective management.
Pediatric services, including oral and vision care benefit includes regular checkups, immunizations, preventive care, and vision and dental services for children. This benefit ensures that children receive the necessary medical care and support to promote their health and development.