Affordable Care Act: Essential Health Benefits

There are a set of health care service categories (essential health benefits) that must be covered by certain plans, starting in 2014.

This protection addresses two challenges for consumers currently face.  It is difficult to know exactly which health benefits are included in insurance plans. Also, some plans do not provide adequate benefits for enrollees and exclude coverage for services most people will need at some point in their life.

The Affordable Care Act ensures health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, offer a comprehensive package of items and services, known as essential health benefits (grandfathered and self-insured policies are exempt).  Essential health benefits must include items and services within at least the following 10 categories (Pediatric services includes dental): 

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance abuse disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Habilitative and rehabilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services, and chronic disease management
  10. Pediatric services, including children’s dental and vision

 Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace, and all Medicaid state plans must cover these services by 2014.

Miller Insurance has health insurance specialists who are certified and can help you understand your options and make the best decision when choosing your plan.

Call or stop by one of our three convenient locations in Bloomington, Colfax, and Gridley.