3 benefits Marketplace health plans must cover

Published on September 12, 2019

All Marketplace plans cover essential health benefits, pre-existing conditions, and preventive care. This is true for all plan categories (all “metal levels,” including Catastrophic plans) and all plan types (like HMO and PPO). Starting November 1, 2019, you can enroll in or renew a plan for 2020, so you can continue to get these benefits.

What are essential health benefits?

• Essential health benefits cover doctor’s visits, prescriptions, hospitalizations, pregnancy, and more. See the full list.
• These benefits are covered by all Marketplace plans. Specific services covered in each broad benefit category may vary based on your state’s requirements.

Is treatment for my pre-existing condition covered?

• All Marketplace plans must cover treatment for pre-existing medical conditions. This means no insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started.
• If you’re pregnant when you apply, an insurance plan can’t reject you or charge you more because of your pregnancy.

Are preventive health services included with Marketplace coverage?

• Marketplace plans cover a set of preventive services, like shots and screening tests, which are free to you when delivered by a doctor in your plan’s network.
• There are 3 sets of free preventive services for adults, women, and children. Check out the lists here.

Note: Health plans can offer other benefits, like vision, dental, or medical management programs for a specific disease or condition. You’ll see exactly what each plan offers when you compare on HealthCare.gov.