“How do I know if my health plan covers me and/or my family?”   

Many don’t realize how important health coverage is until a serious accident or sickness occurs. With health coverage, you can avoid unexpected high medical bills. However, without coverage through the Marketplace you may have to pay a penalty. 

If you purchased health care coverage through the Marketplace, your plan protects you in the following ways:

  1. Meeting your deductible: after you’ve met your deductible, your plan can cover between 60% and 90% of your medical expenses.
  2. Reduced out-of-pocket: once all deductibles and copayments have been paid, your plan will cover you for the rest of the year.
  3. No limits: on the annual amount an insurer will pay for individual medical expenses.

 

All plans must offer these essential health benefits to meet the requirements as an acceptable health coverage plan under the ACA:

  • Emergency services
  • Hospitalization (such as surgery)
  • Pregnancy, maternity, and newborn care
  • Mental health and substance use disorder services (such as behavioral health treatment and counseling services)
  • Ambulatory patient services (outpatient hospital care)
  • Prescription drugs
  • Laboratory services
  • Pediatric services
  • Preventative and wellness services (chronic disease management)
  • Rehabilitative and habilitative services and devices (services for those with injuries or disabilities who need assistance recovering mental and physical skills)

 

Are the plans the same for every state?

The Marketplace offers many of the same plans across the U.S. However, there are a few states that differ in specific benefits. You will be able to view a comparison of plans and what they offer on www.healthcare.gov.

 

For more information regarding the ACA, please visit our resource page. Stay informed on important healthcare issues by subscribing to our free newsletter.