Essential Health Benefits of the Affordable Care Act

The Affordable Care Act (ACA) mandates that all healthcare plans offered in the United States provide coverage for certain “essential benefits” beginning in 2014. Also known as mandated benefits, these benefits are designed to ensure every American receives coverage for their basic healthcare needs. The ACA has also mandated these benefits be extended to state Medicare and Medicaid programs.

Prescription Drugs

Under the ACA, all health care plans must cover at least one prescription drug in every class/category of approved medications in the United States. Furthermore, any patient costs for medication must now be applied towards the policy holder’s annual out-of-pocket expenses.

Mental Healthcare

With today’s increased focus on the importance of mental health, insurance plans must now offer coverage for mental and behavioral health services. Specific coverage varies from state to state, with some states requiring a set copay and others placing a cap on the number of approved therapy sessions per patient each year.

Rehabilitative Services

For both short and long-term rehabilitation from injuries and illnesses, the Affordable Care Act now requires insurance companies to provide coverage for therapy needed to help patients recover. This could include anything from medical equipment (canes and wheelchairs) to physical therapy sessions.

Laboratory Services

All preventative screenings, including pap smears for women and prostate exams for men, are now required to be covered under the ACA.

Maternity/Newborn Care

This was one of the major changes under the ACA, as many insurance plans did not offer this type of coverage in the past or if they did, charged more to include it as an addition rider. Today, all plans are required to cover prenatal care, childbirth, and infant care following delivery.

Pediatric Care

In addition to newborn care, children under the age of 19 will also be entitled to teeth cleanings, X-rays, and other basic medical/dental care under the ACA.

Preventative Services

As a result of the ACA, many insurance plans provide coverage for a range of preventative services and may not charge an copayments, deductibles or coinsurance to patients receiving preventative care. Preventative care includes: medical tests, immunizations, screening labs, preventative medications and other services that would prevent disease.

Hospitalization

Insurance companies must now cover hospitalization for serious medical issues under the new law. However, policyholders should review their policies carefully, as they may still be required to meet their annual out-of-pocket maximums before this coverage will kick in.

Emergency Care

In the event of a medical emergency, the ACA mandates you cannot be charged extra for seeing an out-of-network provider and that you no longer need pre-authorization to visit an emergency room.

Outpatient Care

Most plans already provide coverage for outpatient care, but the ACA has made coverage minimums, including network sizes, much more strict.

These are the 10 health care benefits that are now considered “essential” under the Affordable Care Act. Need to shop for a health insurance plan? Visit the FMA Health Insurance Exchange to find the perfect plan for you today.