Find out what Marketplace health plans cover

Published on October 11, 2018

All Marketplace plans cover the same set of essential health benefits, preventive care, and pre-existing conditions. Starting November 1 you can enroll in or renew a plan for 2019, so you’ll continue to have access to these benefits.

What are essential health benefits?

• Essential health benefits are a set of 10 categories of services — including doctor's visits, inpatient and outpatient hospital care, prescription drugs, pregnancy and childbirth, mental health, and more — that health insurance plans must cover.
• Plans must also offer birth control and breastfeeding coverage.
• These are the minimum requirements for all Marketplace plans. Plans may offer more benefits. You’ll see exactly what’s covered when you compare plans.

What’s preventive care?

• Most health plans must cover a set of preventive services — like shots and screening tests — at no cost to you.
• Preventive services are used to prevent illnesses, disease, and other health problems, or to detect illness at an early stage when treatment is likely to work best.
• These services are free only when delivered by a doctor or other provider in your plan’s network.

What’s coverage for pre-existing conditions?

• All Marketplace plans must cover treatment for pre-existing medical conditions, like asthma, diabetes, or cancer.
• Marketplace plans can’t deny you coverage or raise your rates based only on your health.
• Pregnancy is also covered from the day your plan starts.