Posted 10/26/2013 By

Obamacare 101: What Are The Essential Benefits Of The New Health Plans?

Starting on January 1st, 2014, all new individual, family, and small business health plans are required to cover ten essential benefits under the Affordable Care Act.

This page:

Introduces the concept of essential benefits.

Explains how these health benefits are covered under the new law

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The Essential Benefits That Make Up The Core Of Obamacare Health Plans

There were many reasons for reforming health care in the United States, among them skyrocketing costs, insurers refusing to pay claims on technicalities, large number of uninsured families and individuals, etc.

One that stood out in the eyes of those working in the health care industry, as well as the patients who have to deal with their health care providers and insurers, was the staggering number of different plans and options that sowed confusion among consumers, and led to many nasty surprises when certain benefits taken for granted were in fact unavailable and/or uncovered.

The Affordable Care Act seeks to reduced this confusion by creating four distinct tiers of plans (the Bronze, Silver, Gold, and Platinum plans), as well as establishing ten essential benefits which all new individual, family, and small business health plans must provide.

These essential benefits are:

Ambulatory Services: not to be confused with "ambulance services", these are outpatient services like doctor's visits or outpatient surgery, as well as in-home care and some hospice care (the duration of which is be capped, depending on the plan).

Lab services: any screening for illness, including cancers, done as part of a hospitalization or outpatient care.

Maternity and newborn care: any and al care expectant mothers receive, including screenings, labor and delivery, as well as all care for newborns.

Hospitalization: possibly the biggest health-related expense anyone has to ever tackle, hospitalization is an essential benefit under the ACA; this includes all doctor visits, nursing care, the actual hospital stay (room and board), all tests, surgeries, etc.

Addiction and mental health treatment: includes both inpatient and outpatient treatment of mental illness and addiction disorders; some plans will limit care to 20 days per year.

Rehabilitative services: this category of care is designed to help patients return to normal life after injury, hospitalization, surgery, etc. Also included is care for chronic conditions.

Prescription medication: any and all drugs prescribed by a physician in ambulatory care as well as during hospitalization; this category also includes all medication taken on an ongoing basis to treat chronic conditions, such as high cholesterol, diabetes, etc.

Pediatric care: includes all health care provided to children, including special immunizations services, as well as dental and vision care which must be provided to children up to age 19.

Preventive and wellness care: includes the care for chronic conditions such as diabetes, heart disease, etc. Also include screenings for cancer and other diseases.

Emergency care: (out-of-network emergency services are also covered); another "big ticket expense" that is central to the function of Obamacare; because all emergency services (including ambulance rides) must be covered by every plan, hospitals and states will not be stuck paying the bills of those who show up in emergency rooms without insurance, as had been so commonly the case in the past.

If you are one of these millions of uninsured, or if you would simply like to see if you qualify for a subsidy under Obamacare, visit Ehealth, where you can research various plans and options available in your state, as well as actually purchase health insurance today.


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