What Are the 10 Essential Benefits?
Typically, all carriers in all states have those 10 essential benefits. Some of them will have a bit more to offer. We got ambulatory patient services, which mean outpatient coverage (not being inpatient in the hospital). There is also emergency services – a.k.a. emergency room care. Also, we have hospitalization like inpatient and surgeries that are on an inpatient basis. We also have laboratory services, as well as preventive and wellness benefits. So, everybody from wellness-baby visits to routine annual physicals, mammograms, and cat scans. This covers 100% before getting co-pays or any of that.
Then, there’s maternity and newborn coverage care. Basically, it lasts from when she first finds out she’s pregnant all the way through until she delivers, and then the baby will be taken care of. After that, they can have the baby added to their own policy. Once added to the health plan, they can utilize the pediatric services, which include oral and vision care. The oral and vision benefits for pediatrics do not apply to adults. When it comes to adult’s benefits, it has to be separate. That’s not part of the essential benefits provided under the Affordable Care Act.
There is also coverage for substance abuse disorders that covers alcohol and drug, including mental illness coverage. This one covers inpatient and outpatient. What they’re talking about here is outpatient prescription drug coverage. Lastly, qualified health plans include rehab services as well for people dealing with injuries, disabilities, chronic conditions. Those would be covered so they can have the ability to make you better.
Since insurance is often times overwhelmingly confusing, we want to shed light on this industry by answering YOUR questions. So if you have any questions or concerns, comment below and your question may be the topic of our next video!
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