Marketplace Health Plan Benefits
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:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (such as surgery)
- Pregnancy, 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, including oral and vision care
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. Be sure to read the summary of benefits to understand what exactly is covered under your plan.
Additional benefits information:
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