10 essential benefits

Today, the Affordable Care Act requires all health plans to provide the same set of essential health benefits. You might be surprised to find out that you're now covered for things you weren't before.

Tip:

Your preventive care is now required to be 100 percent covered by your health insurance plan. So, there's no copay or deductible or coinsurance to pay for your annual checkups.

 1. Ambulatory care

This is care you receive without being admitted to a hospital, such as at a doctor's office, clinic or same-day (outpatient) surgery center. It also includes home health services and hospice.

 2. Emergency services

This includes trips to the ER and ambulance transportation. An emergency is a condition that could lead to serious disability or death if not treated right away, such as accidents and sudden illnesses. In an emergency, you're covered equally at network and out-of-network facilities, and you don't need prior authorization.

 3. Hospitalization

This is care you receive as a hospital patient. It includes:

  • Services provided by doctors, nurses and other hospital staff
  • Lab work and other tests
  • Medications you receive during your stay
  • Room and board

The benefit also covers surgeries, transplants and care received in a skilled nursing facility, such as a nursing home care for the elderly.

 4. Laboratory services

This benefit covers tests that help a doctor diagnose an injury, illness or condition, or those tests that measure a treatment's effectiveness. Some preventive screenings, such as breast cancer screenings, are covered at 100 percent.

 5. Maternity and newborn care

This benefit is for the care that women receive while pregnant and during labor, delivery and post-delivery. It includes care for newborns.

 6. Mental health services and addiction treatment

You're covered for inpatient and outpatient care that evaluates, diagnoses and treats a mental health condition or substance abuse disorder.

 7. Rehabilitative services and devices

This benefit covers rehabilitative and habilitative services and devices that help you gain or recover mental and physical skills lost due to an injury, disability or chronic condition.

 8. Pediatric services

Infants and children are covered for their care, including well-child visits and recommended vaccines and immunizations.

 9. Prescription drugs

This benefit covers prescription medications that treat an illness or condition, for example:

  • Antibiotics to treat an infection
  • Medications taken for an ongoing condition, such as high cholesterol
 10. Preventive and wellness services and chronic disease treatment

You're covered for preventive care, such as physicals, immunizations and cancer screenings that prevent or detect certain medical conditions. You're also covered for care to treat chronic conditions, such as asthma and diabetes.