All plans offered in the Marketplace cover the same set of essential health benefits.
Every health plan must cover the following services:
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 state’s requirements. Plans may offer additional benefits, including:
When comparing plans, you’ll see exactly what each plan offers.
Generally, yes. But some states require insurers to cover additional services and procedures. Even within the same state, there can be small differences.
When you compare plans in the Marketplace, you'll see the specific benefits each plan offers.
Plans may cover other services. When you compare plans, you’ll see more detailed information about what’s covered. If you want to find out if a particular service is covered, call the plan.
Yes. Any plan shown in the Marketplace includes these essential health benefits. This is true for all plan categories (all “metal levels,” including Catastrophic plans) and all plan types (like HMO and PPO).
Some preventive care services are free, and some plans cover other services without out-of-pocket costs.
It depends. Large employers who "self-insure” — meaning they pay employees' health care costs directly — don't have to provide essential health benefits. But many do. Check with your employer to find out if it’s self-insured and what services are covered.