Does my Health Insurance Plan

Does my health insurance coverage dental

Every health plan must cover the following services:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (like surgery and overnight stays)
  • 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
  • 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:

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:

When comparing plans, you’ll see exactly what each plan offers.

More answers

Are the benefits the same in each state?

Generally, yes. But some states require insurers to cover additional services and procedures. Even within the same state, there can be small differences.

When you compare plans in the Marketplace, you'll see the specific benefits each plan offers.

What if I need a specific treatment that's not on this list?

Plans may cover other services. When you compare plans, you’ll see more detailed information about what’s covered. If you want to find out if a particular service is covered, call the plan.

Do all types of Marketplace plans cover essential health benefits?

Yes. Any plan shown in the Marketplace includes these essential health benefits. This is true for all plan categories (all “metal levels, ” including Catastrophic plans) and all plan types (like HMO and PPO).

Do I have to pay deductibles and copayments for essential health benefits?

Generally, yes. All Marketplace plans have deductibles, copayments, and other out-of-pocket costs that apply to most covered services.

Some services are free, and some plans cover other services without out-of-pocket costs.

Do I get these benefits if my company is self-insured?

It depends. Large employers who "self-insure” — meaning they pay employees' health care costs directly — don't have to provide essential health benefits. But many do. Check with your employer to find out if it’s self-insured and what services are covered.

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