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Health benefits & coverage

What Marketplace health insurance plans cover

All plans offered in the Marketplace cover these 10 essential health benefits:
  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (like surgery and overnight stays)
  • Pregnancy, maternity, and newborn care (both before and after birth)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care (but adult dental and vision coverage arenโ€™t essential health benefits)

Additional benefits

Plans must also include the following benefits:
Essential health benefits are minimum requirements for all Marketplace plans. Specific services covered in each broad benefit category can vary based on your stateโ€™s requirements. Plans may offer additional benefits, including:
  • Dental coverage
  • Medical management programs (for specific needs like weight management, back pain, and diabetes)
When comparing plans, youโ€™ll see exactly what each plan offers.

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