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:
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 include:
QUESTION DROPDOWN TOKEN
Not necessarily. Many grandfathered plans cover the essential health benefits. But grandfathered plans are not 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.
Learn more about your rights and benefits under a grandfathered health plan.
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.
When you fill out your Marketplace application and compare plans, you'll see the specific benefits each plan offers. Read the plan details carefully before you enroll.
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.
Some preventive care services are free, and some plans may provide certain other services without out-of-pocket costs.
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 do not 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.