If I had insurance before the Marketplace and I have a grandfathered plan do I receive essential health benefits? 

The coverage from a grandfathered plan may not include the ten essential health benefits. They are not required to offer them, To learn what your benefits are, contact your employer or health insurance provider. 


Does every state offer the same benefits? 

In general, all states are offering the same set of essential health benefits. However, specific benefits may vary from state to state. Some states may place more stringent requirements on insurance companies to cover certain treatments.
There are also some differences from plan to plan. When you apply for coverage
from the Marketplace, information on the specific benefits offered by each plan
is available to you. Be sure to read plan details carefully before making a decision. 

 

What if I need a treatment that does not fall into the essential health benefits? 


The essential health benefits is a very broad guide for what insurance plans must cover. They include a large number of individual services. During enrollment, you are able to compare marketplace plans in detail and see which one provides the best coverage options for you.

 

Are the essential health benefits covered by each plan category—bronze, silver, gold, and platinum? 

 

Yes. For a plan to be offered on the Marketplace it must cover the essential health benefits. This also applies to catastrophic plans. 


Are the essential health benefits covered by all types of plans available on the Marketplace? PPOs HMOs and high deductible plans? 


Yes For a plan to be offered on the Marketplace it must cover the essential health benefits.

 

Do I have to pay a copay or deductible for essential health benefits? 

In general, yes. Some preventive care services are free and some plans may choose to provide other services without out-of-pocket costs. All marketplace plans have deductibles, copayments, and other costs not covered by the plan that apply to most benefits. Costs differ on which levelplan you choose. 

 

My company self-insures. Do I get these benefits? 

 

It depends.
Many large companies pay the costs of employees’ health care directly. Many of the plans they provide do cover essential health benefits. However they are not legally mandated to do so. To get accurate and complete information about what health benefits your plan covers, contact your employer. 

 

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Health Care Benefits-Frequently Asked Questions

Health Care Benefits

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