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Plans under the Affordable Care Act (ACA) must cover 10 essential categories of health services. Doctor’s services; emergency services; hospitalization; pregnancy, maternity and newborn care; mental health services and substance use disorder services; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services must be covered under ACA plans.
Ambulatory Patient Services
These are outpatient services, like the services covered under Medicare Part A. This includes doctor’s services and surgery where they don’t keep you overnight.
Emergency Services
In the event of an emergency, you must be covered at the in-network rate for any emergency services you receive.
Hospitalization
When you stay overnight or as an inpatient in a hospital, you must be covered under your ACA insurance plan.
Pregnancy, Maternity and Newborn Care
Your insurance plan is required to pay for the care of yourself and your unborn baby. It also must cover the costs of the delivery and care after birth for you and your baby, and must cover birth control and breastfeeding services.
Mental Health and Substance Use Disorder Services
Your plan must cover behavioral health treatment, including counseling or psychotherapy services as part of your mental health benefit.
Prescription Drugs
Your insurance plan must cover at least one drug from each category of approved drugs. The plan will not cover every available drug, but they will offer a list of covered drugs called a formulary and will pay for a portion of the costs for those approved medications.
Rehabilitative and Habilitative Services and Devices
Rehabilitative and habilitative services and devices are covered, which is especially helpful for people dealing with chronic conditions, disabilities or injuries.
Laboratory Services
When your healthcare provider orders a test to aid in diagnosis, this is covered as a laboratory service.
Preventive and Wellness Services and Chronic Disease Management
Many things fall under preventive services. Each year you can have a wellness visit with your doctor. You also get annual exams and vaccinations. Some preventive services through in-network providers, such as mammograms and pap smears, are covered at no cost to you.
Pediatric Services
Covered pediatric services include vision and dental care.
Do you need assistance finding an ACA plan that fits your needs and budget? The essential coverage only tells part of the story here. Plans differ in premiums and copayments, along with covered medications and networks of health care professionals in your area. Speak with an agent from Insured For Life to learn more about finding your match.
