The 10 Essential Benefits and Our Plans
All the health plans offered on the Health Insurance Marketplace must cover 10 specific services. Marketplace insurance plans cover these services or benefits because under the Affordable Care Act they are required or “essential” benefits.
The essential benefits include:
- Ambulatory patient services.
This includes all outpatient services that you receive without admission to a hospital, such as walking into your primary care provider’s office for a regular visit.
- Emergency services.
This service is provided when you go to the emergency room for urgent situations or conditions. You cannot be charged extra for an out-of-network visit.
This benefit includes inpatient care such as surgery and overnight stays in the hospital.
- Pregnancy, maternity and newborn care.
Under this benefit, healthcare coverage is provided both before and after birth.
- Mental Health and substance use disorder services.
Behavioral health treatment, counseling and psychotherapy, are part of this service.
- Prescription drugs.
Under this benefit, all plans must cover at least one drug from every category listed in the U.S.
- Rehabilitative and habilitative services and devices.
This benefit focuses on services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills.
- Laboratory services.
This benefit includes testing to diagnose diseases and injuries, to determine whether a treatment or service is effective, as well as some preventive screenings.
- Preventive and wellness services and chronic disease management.
The goal of this benefit is to get people to see their primary care provider before they get sick. It includes many preventive services covered by your plan at no extra cost.
- Pediatric services.
This includes dental and vision care for children under age 19.
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Levels of Coverage
Under the Affordable Care Act, there are four levels of coverage on the Marketplace Exchange:
The categories have nothing to do with the amount of care or quality of care you receive. The plans in these metal levels differ based on how the plan share the costs of care with the member, which is called actuarial value (AV).
AmeriHealth Caritas Next offers one gold plan, three silver plans, and two bronze plans. All of these plans cover the 10 essential benefits.
Get information on the Marketplace plans we offer and find a plan that meets your healthcare needs.