Ten Essential Health Benefits Covered in the New Marketplace Health Plans

We know health reform is big and confusing. Some parts of the law started in 2010. Other parts are rolling out over the next several years. Texas physicians and the Texas Medical Association have carefully studied the law to help you understand what the changes mean to your health care. 

As the Affordable Care Act (ACA) continues to roll out, Me&My Doctor’s “Hey Doc” series will answer your frequently-asked questions, as well as some you might not have thought to ask. 

Check out part 10 in this series.

Q. What is covered by this insurance?

A. All plans in the marketplace have to offer what’s called “essential health benefits.” This is a basic package covering 10 different categories:

1. Doctor visits;
2. Hospital visits;
3. Prescription drugs;
4. Lab tests;
5. Emergency room visits;
6. Care when you are pregnant and when you have your baby;
7. Care for children;
8. Preventive services that help you stay healthy, like shots and screenings;
9. Mental health care like counseling; and
10. Treatments that help you recover from injuries.

Some plans might cover more than that, but that’s the minimum. You can also find dental coverage in the marketplace, either included in a plan you buy, or separately.
Marketplace plans also must cover what are called “preexisting health conditions.” This means even if you are already sick or pregnant, insurance companies can’t turn you away or charge you more for your insurance because of that.