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
- Preventative and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
Additional Benefits
Plans must also include the following benefits:
- Birth control coverage
- Breastfeeding coverage
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:
- Dental coverage
- Vision coverage
- Medical management programs (for specific needs like weight management, back pain and diabetes)
When comparing plans, you will see exactly what each plan has to offer.
For assistance in choosing or comparing Marketplace Plans, or for free quotes or assistance in enrolling in a healthcare plan, please reach out to us at (623) 889-7600. We can help you streamline the process as well as help you throughout the year with any assistance or issues, including claims, requesting cards, understanding benefits and more!