All plans on the Marketplace offer the same essential benefits. This means free preventative services and care. All health plans must offer these benefits.
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)
Pregnancy, maternity, and newborn care (both before and after birth)
Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
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
Preventive and wellness 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 for women:
Birth control coverage
Breastfeeding coverage
These health benefits are essential and may vary depending on which state you reside.
Some other plans offer essential benefits including:
Dental coverage
Vision coverage
Medical management programs (for specific needs like weight management, back pain, and diabetes)
When comparing plans, you’ll see exactly what each plan offers.
The Affordable Care Act eliminated caps on how much coverage people got for these essential health benefits
The ACA elimated these caps to give patients more access to health services while taking away the financial burden.
Contact Cosmo if you have questions about your health care benefits and how to use them.
Get ready for New Jersey’s open enrollment period. Open enrollment starts November 1st and goes until December 15th. Contact Cosmo to schedule a consultation today.
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