Health insurance plans normally cover the following:

• 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 (what-if-I-am-pregnant or plan-to-get-pregnant)
• Mental health and substance use disorder services (coverage/mental-health-substance- includes counseling and psychotherapy)
• Prescription drugs
• Rehabilitative and habilitative services and devices (services and devices to help people with mental and physical skills)
• Laboratory Services
• Preventative and wellness services (coverage/preventative-care-benefits) and chronic diseases
• Pediatric services, including oral and vision care (but adult dental and vision coverage

Additional Benefits

Plans must also include the following benefits:

• Birth Control Coverage (coverage/birth-control-benefits)
• Breastfeeding Coverage (coverage/breast-feeding-benefits)
• Dental Coverage (coverage/dental-coverage)
• Vision Coverage (glossary/vision-or-vision-coverage)
• Medical Management Programs (for specific needs like weight management, back pain etc.

More Questions

Are the benefits the same in each state?
What if I need a specific treatment that’s not on this list?
Do all types of Marketplace plans cover essential health benefits?
Do I have to pay deductibles and copayments for essential health benefits?
Do I get these benefits if my company is self-insured?
Do I get these benefits if I have a grandfather plan?

WHAT ARE DEDUCTIBLES?
Deductibles are out of pocket costs that are paid by the insured.

Preventative Services
Routine benefits are for checkups or patient counselling to prevent illness, diseases or other health problems are all covered under health insurance plans