Q&A Topics

Tuesday, October 8, 2013 3:58:12 PM

What are the essential health insurance benefits under Obamacare?

Under the Affordable Care Act, which is also known as Obamacare, there are 10 essential health benefits that insurance plans must cover both inside and outside of the health insurance exchanges or marketplaces. 

They are a comprehensive package of services that include the following:

    1. Hospitalization
    2. Emergency room care
    3. Maternity and newborn care
    4. Prescription drugs
    5. Lab services
    6. Ambulance service 
    7. Rehabilatative and habilitative services
    8. Mental health and substance abuse services
    9. Preventive and wellness services
    10. Pediatric services, including vision and dental service

There are five different types of plans offered through state health insurance exchanges: platinum, gold, silver, bronze, and catastrophic. All but catastrophic must cover the essential benefits. 

The catastropic option covers basic care only in the event of an emergency, and is available if you are younger than age 30 or unable to get insurance that costs less than 8% of your income.

The following types of coverage meet the essential health coverage requirement:

  • A plan purchased through a state health insurance marketplace
  • An employer plan, including retiree plans
  • Medicare
  • Medicaid
  • The Children's Heath Insurance Program (CHIP)
  • TRICARE (for current service members and military retirees, their families, and survivors)
  • Veterans health care programs 
  • Peace Corps Volunteer plans
To find out if you're eligible for a subsidy that reduces the cost of health insurance with essential benefits, use our Obamacare Eligibility Calculator. You can shop and compare plans approved by the Affordable Care Act, no matter where you live.