What is covered in Marketplace health insurance plans?

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Few groups have benefited more from the passage of the Affordable Care Act (ACA) than Latinos. Since the law went into effect, over 910,000 Latino adults – between the ages of 19 and 26 – who would have previously been without coverage were now eligible to remain on their parents’ plans. Over 4.2 million gained health insurance in that time as well, lowering the rate of Latino uninsured by 7.7%.

With the deadline for the latest phase of Open Enrollment coming to a close on January 31, 2017, many are still without coverage. This is partly due to the fact that many do not know what is covered through plans available in the Health Care Marketplace.

What Marketplace Plans Cover

All plans that are available through the Marketplace cover the same set of “essential health benefits.” This includes ambulatory patient services, which is the care you can get without being admitted to the hospital. Also, emergency services (trips to the emergency room) and hospitalizations, such as overnight stays and surgical procedures are covered.

For expectant or pregnant mothers, pregnancy, maternity, and newborn care – both before and after your baby is born – are covered, along with mental health and substance use disorder services. Counseling and psychotherapy appointments and treatments are covered under behavioral health plans.

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Prescription drugs and rehabilitative services – such as those made necessary due to chronic injuries, surgical procedures, and workplace injuries – are covered; as are laboratory services, preventative and wellness services, and pediatric oral and vision care.

Birth control and breastfeeding coverage are also part of the basic plans.

What Else is Offered

While children’s dental and vision care is included as part of the basic plans, these are added benefits for adults. Medical management programs, such as those for weight management, back pain, and diabetes, are also additional benefits that can be purchased.

When shopping for a plan, it is important to determine what you will need for this year. Many people are eligible for financial assistance. This can also be determined on the site.

Read more about shopping for health care plans through the Marketplace here.

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