Essential benefits covered in the Marketplace
Katie Carpenter | 10.08.13
The Affordable Care Act ensures access to 10 essential medical benefits in all plans purchased within the Health Insurance Marketplace.
All private health insurance plans offered in the Marketplace will 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:
Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (such as surgery)
- Maternity and newborn care (care before and after your baby is born)
- 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
In addition to ensuring these benefits are covered for the uninsured, the new set of standards also aims to improve quality of life for those who do not have adequate coverage in their current plans.
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.
PinnacleHealth has employed certified applications counselors to assist people apply for coverage. The counselors are available by appointment by calling (717) 231-8900 or toll free (877) 499-3299.
There are 3 key dates you'll want to mark on your calendar:
- October 1, 2013: Marketplace open enrollment started
- January 1, 2014: Health coverage can start
- March 31, 2014: Open enrollment ends
Visit the official Health Insurance Marketplace to shop for plans.
Questions? Call 1-800-318-2596, 24 hours a day, 7 days a week. (TTY: 1-855-889-4325)