10 Essential Health Benefits Under Obamacare

While it is difficult to tell what will happen with the Affordable Care Act there are 10 essential health benefits that this law says must be met on all health plans offered to those who buy health insurance on their own or in small groups .  Large employers are not required to offer these benefits but it is expected that most already do or will.    The bill would like to establish these 10 benefits as a standard for health insurance coverage.  A study by an independent research firm shows that on average 76% of these benefits are offered by insurance plans today.   These 10 benefits are:

  1. Emergency care –  Under the Affordable Care Act visits to the emergency room do not require preauthorization and the patient cannot be charged out of network
  2. Prescription drugs – The biggest part of this part of the bill is that it narrows and eventually closes the Medicare Part D doughnut hole which is a gap in drug coverage when over $2970 per year is spent on medications.
  3. Outpatient care –  This is offered by most insurance plans now as it is the most common form of healthcare.
  4. Mental health services – Some states already have legislation in place regarding mental health coverage. The Affordable Care Act will require mental health be covered but copays may be as much as $40 and may be limited to a certain number of annual visits
  5. Hospitalization – Coverage for hospital visits will be required but patient costs may still be fairly high.
  6. Rehabilitation and Habilitation services – While most insurance plans cover rehab services the new law will also cover habilitative services which are therapies for long-term disabilities.
  7. Preventative wellness – The US Preventive Services Task Force lists 50 preventive services which the new law will cover at no extra cost to the insured.  Medicare beneficiaries may be able to receive additional screenings copay and deductible free.
  8. Laboratory services – Lab services will include preventative screening tests.
  9. Pediatric care – Some dental and vision coverage will be covered for children under the age of 19 including 2 teeth cleanings per year, X-rays, fillings and medically necessary orthodontics.  Also covered are one eye exam and pair of glasses or contacts for anyone under the age of 19.
  10. Maternity and newborn care – Prenatal care is classified as preventive under the new law and must be covered at no extra cost.  Also covered are childbirth and newborn care.

Remember that not all insurance plans are required to conform to these rules .  These laws are for insurance plans that are offered to those who buy health insurance on their own or in small groups.  Many insurance plans already include many of these.


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