What's always covered with every plan?

Under the Affordable Care Act (ACA), commonly referred to as Obamacare, preventative care (annual checkups, preventative tests, immunizations) is covered at no out-of-pocket cost for any non-employer health insurance plan (i.e. an individual plan).

Additionally, all individual plans must cover 10 “essential benefits.” While these services are not free (the cost to you depends on the specific plan you choose), all plans must provide coverage for these situations. The “essential benefits” covered under the ACA include:

  • Ambulatory patient services (outpatient care)
  • Emergency services (trips to the ER)
  • Hospitalization (inpatient care)
  • Maternity and newborn care
  • Mental health services and addiction treatment
  • Prescription drugs
  • Rehabilitative services and devices
  • Laboratory services
  • Wellness services and chronic disease treatment
  • Pediatric services

Keep in mind that your coverage specifics will depend on the type of plan, network, and specific carrier that you select.

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