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Essential Health Benefits

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Essential Health Benefits

The Affordable Care Act (ACA) ensures that all individual and small group health insurance plans, whether you buy them on your own (off the Marketplace) or through the government Marketplace, provide a certain baseline level of coverage. These are called essential health benefits, and they are designed to guarantee that you have access to important medical services regardless of the specific plan you choose.

It's important to remember that these are minimum requirements. While all Marketplace plans must cover essential health benefits, some plans may offer additional coverage on top of what's mandated by law. This means it's always a good idea to compare different plans side-by-side to see exactly what each one covers before making a decision.

So, what exactly are essential health benefits? Here's a breakdown of the ten key categories:

Ambulatory patient services: This covers any care you receive from a doctor or other healthcare professional outside of a hospital setting, such as checkups, preventive screenings, and treatment for various illnesses.
Emergency services: If you have a sudden medical emergency, essential health benefits ensure your plan covers the costs associated with getting the care you need, including ambulance rides and emergency room visits.
Hospitalization: This covers any hospital stay you may require, including inpatient care, surgery, and related services.
Maternity and newborn care: Essential health benefits guarantee coverage for prenatal care, childbirth, and postpartum care for both you and your newborn baby.
Mental health and substance use disorder services: This category ensures your plan covers treatment for mental health conditions and substance abuse disorders, including therapy and counseling services.
Prescription drugs: Essential health benefits require plans to cover a range of prescription medications to treat various health conditions.
Rehabilitative and habilitative services and devices: If you have an injury, disability, or chronic condition, this benefit helps cover services and devices that can assist you in regaining or improving your mental and physical skills.
Laboratory services: This covers any lab tests your doctor may order to diagnose or monitor a medical condition.
Preventive and wellness services and chronic disease management: Essential health benefits ensure your plan covers preventive care like checkups and screenings, as well as ongoing management for chronic health conditions.
Pediatric services including oral and vision care: This category guarantees coverage for essential healthcare services for your children, including checkups, immunizations, dental care, and vision care.

It's important to note that under the ACA, all health plans, regardless of size or funding structure (including self-funded plans), must cover essential health benefits without placing any annual or lifetime limits on these covered services.

This is just a basic overview to help you understand essential health benefits. Before buying any health insurance plan, it's crucial to carefully review the details of the specific plan you're considering to ensure it covers the services that are most important to you and your family.

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Choice Benefit Services

We extend coverage to individuals and businesses in Auburn, New Hampshire and surrounding areas.

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Important notices regarding Medicare Plans: This information has not been endorsed or reviewed by Medicare. We are not affiliated with any United States Government or State agency. We may not offer every plan available in your area. The information we provide is limited to the plans we offer in your region. For information on all available options, please contact Medicare.gov or call 1-800-MEDICARE.

Essential Health Benefits

Essential Health Benefits

So, what exactly are essential health benefits? Here's a breakdown of the ten key categories:

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