Essential Health Benefits

All health insurance plans available through Connect for Health Colorado are required by federal law to include what are called essential health benefits, including a set of free, preventive services. These are the minimum requirements for all Marketplace plans meaning coverage is more comprehensive and it’s easier for you to compare plans. It has also prevented the selling of skimpy plans that were cheap, but didn’t cover many services – often leaving consumers with big bills when they needed care.

This doesn’t mean that all plans are the same. Some plans may offer a higher level of service or additional services beyond the minimum required, or exclude other optional services that may be important to you. It’s important to understand these differences when comparing and choosing a plan to meet your needs and budget.

These health benefits and services that include:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (like surgery and overnight stays)
  • Pregnancy, maternity and newborn care (both before and after birth)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services (for free) and chronic disease management
  • Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

Note regarding chiropractic care: Any provider, including (but not limited to) Doctors of Chiropractic, can provide care for the essential health benefits that are within his/her scope of practice under Colorado law. For those individuals interested in obtaining essential health benefits, as well as other services, from a Doctor of Chiropractic, check to see what providers are in the health insurance company’s network of providers.

Free preventive health services

As part of the essential health benefits, all health insurance plans must cover a set of preventive services — at no cost to you. These services are free, even if you haven’t met your deductible, only when delivered by a doctor or other provider in your plan’s network. Make sure you take advantage of these free services to stay healthy throughout the year – and save you money in the long run!

As of 2017, these are the 18 free preventive services for all adults as outlined by

  1. Abdominal aortic aneurysm one-time screening (for men of specified ages who have ever smoked)
  2. Alcohol misuse screening and counseling
  3. Aspirin use to prevent cardiovascular disease (for men and women of certain ages)
  4. Blood pressure screening
  5. Cholesterol screening (for adults of certain ages or at higher risk)
  6. Colorectal cancer screening (for adults over 50)
  7. Depression screening
  8. Diabetes (Type 2) screening (for adults with high blood pressure)
  9. Diet counseling (for adults at higher risk for chronic disease)
  10. Hepatitis B screening (for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence)
  11. Hepatitis C screening (for adults at increased risk, and one time for everyone born 1945 – 1965)
  12. HIV screening (for everyone ages 15 to 65, and other ages at increased risk)
  13. Immunization vaccines (for adults — doses, recommended ages, and recommended populations vary)
  14. Lung cancer screening (for adults 55 – 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years)
  15. Obesity screening and counseling
  16. Sexually transmitted infection (STI) prevention counseling (for adults at higher risk)
  17. Syphilis screening (for adults at higher risk)
  18. Tobacco Use screening (for all adults and cessation interventions for tobacco users)

Be aware that some of these screenings are only for certain age groups or risk factors. Review your plan benefits or call your health insurance company to confirm which preventive services are free for you.

Women have their own set of free preventive care benefits. Many of these are related to pregnancy, breastfeeding, and contraception, as well as gender-specific cancers and sexually transmitted diseases.

Children also have their own set of free preventive care benefits. These tend to center around well-child visits, immunization vaccines, behavioral issues, developmental disorders and screenings for common chronic illnesses that can develop in children.

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