What Does My Marketplace Health Plan Cover?

Content From: HealthCare.govPublished: July 09, 20211 min read


Cross-posted from Healthcare.gov Blog

10 Covered Essential Health Benefits

All private health plans offered in the Marketplace must cover these 10 essential health benefits regardless of the plan category and type. (Note: These are the minimum requirements for all Marketplace plans. Specific services covered in each broad benefit category can vary based on your state's requirements.)

Covered essential health benefits

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Pregnancy, maternity, and newborn care (pre and post birth)
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

Other services may be available to you

  • Marketplace plans include breastfeeding and birth control coverage.
  • Your plan may also offer dental and vision coverage and medical management programs (for specific needs like weight management, back pain, and diabetes).

See what else your Marketplace heath plan covers.

Note: PrEP and HIV testing, as well as hepatitis B virus and hepatitis C virus screenings, are covered Preventive Services that are available without charging you a copayment or coinsurance. Hepatitis A virus and hepatitis B virus immunizations, syphilis screening, and STI prevention counseling are covered also.