What will my health insurance cover?

The Affordable Care Act mandated that all health plans in both the small-group and individual markets provide a comprehensive package of services. These are qualified as ‘essential health benefits’ and include the following 10 categories:

  • Ambulatory Patient Services
  • Emergency Services
  • Hospitalization
  • Pregnancy, Maternity and Newborn Care
  • Mental Health and Substance Use Disorder Services, including Behavioral Health Treatment
  • Prescription Drugs
  • Rehabilitative and Habilitative Services and Devices
  • Laboratory Services
  • Preventive and Wellness Services and Chronic Disease Management
  • Pediatric Services, including Dental and Vision Care

Follow this link to find out what preventive services must be covered by all marketplace plans at no cost to you.  These services are provided without charging you a copayment or coinsurance, even if you have not yet met your yearly deductible: https://www.healthcare.gov/preventive-care-benefits/

Note: Grandfathered plans are not required to include the 10 essential health benefits.  Check with your employer or review your explanation of benefits to find out exactly what your plan covers and at what cost.