Obamacare, officially known as the Affordable Care Act (ACA), sets standards for health insurance coverage in the United States. Under the ACA, all health insurance plans offered through the Health Insurance Marketplace, as well as most private health insurance plans, must cover a set of essential health benefits. These essential health benefits ensure that individuals and families have access to comprehensive and necessary healthcare services. Here are the ten essential health benefits required to be covered by Obamacare-compliant health insurance plans:

  1. Preventive and Wellness Services and Chronic Disease Management: Preventive services like vaccinations, screenings, and counseling, as well as services to manage chronic conditions like diabetes and hypertension. Link to covered preventive services.
  2. Ambulatory Patient Services: Outpatient care, including doctor’s office visits, specialist consultations, and outpatient surgery.
  3. Emergency Services: Emergency medical care, including ambulance services, emergency room visits, and urgent care.
  4. Hospitalization: Inpatient care, including hospital stays, surgeries, and associated expenses.
  5. Maternity and Newborn Care: Prenatal and postnatal care, as well as labor and delivery services.
  6. Mental Health and Substance Use Disorder Services: Behavioral health services, including counseling, therapy, and substance abuse treatment.
  7. Prescription Drugs: Coverage for necessary prescription medications, including both generic and brand-name drugs.
  8. Rehabilitative and Habilitative Services and Devices: Services that help individuals regain skills and functioning after an illness or injury, as well as services that assist people with disabilities.
  9. Pediatric Services, Including Oral and Vision Care: Coverage for pediatric dental and vision care, including routine check-ups, eyeglasses, and dental braces.
  10. Lab Tests: Coverage for laboratory tests and services, including blood tests, X-rays, and diagnostic imaging.

It’s important to note that while all Obamacare-compliant plans must cover these essential health benefits, the specific details of coverage, costs, and network providers may vary from one plan to another. Additionally, the ACA prohibits health insurance companies from denying coverage or charging higher premiums based on preexisting conditions, ensuring that individuals with health issues can access the care they need.

When considering an ACA-compliant health insurance plan, it’s essential to review the plan’s Summary of Benefits and Coverage (SBC) to understand the specific details of coverage, deductibles, copayments, and out-of-pocket expenses. This allows individuals to choose a plan that best fits their healthcare needs and budget.