All private health insurance plans offered in the Marketplace offer the same set of essential health benefits. These are services all plans must cover.
The essential health benefits include at least the following items and services:
Note: All Marketplace plans must offer pediatric dental and vision care for children 18 and under. But this isn’t true for adults. You’re not required to have them, but be sure to shop around if you want them.
Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace.
Additional benefits information:
Not necessarily. Many grandfathered plans cover the essential health benefits. But grandfathered plans aren't required to offer them. Check with your employer or health plan to find out if your plan is grandfathered and learn what benefits it offers.
Generally, yes. But while all Marketplace plans offer the same general set of essential health benefits, specific benefits may be different in each state. Some states require insurers to cover certain services and procedures. Even within the same state, there can be small differences between plans.
Plans cover many individual services within the broad categories on the list of essential benefits. When you compare plans in the Marketplace, you’ll be able to see more detailed information about covered benefits.
Yes. All plans available on the Marketplace must cover the essential health benefits. Learn more about different types of health plans.
Generally, yes. All plans in the Marketplace will have deductibles, copayments, and other out-of-pocket costs that apply to most benefits. These costs differ in part based on what category of plan you choose.
Not necessarily. Many large employers "self-insure." This means they pay the costs of employees' health care directly. Many of them cover the essential health benefits. But companies that self-insure don't have to provide this package of benefits. Check with your employer to find out if it is self-insured and learn about your covered benefits.