What services do health plans sold on the Marketplace cover?

All health plans offered by the Individual and Small Business Marketplaces include a comprehensive set of benefits, as required by federal regulations, and are considered Minimum Essential Coverage. These benefits fit into the following 10 categories:

  • Ambulatory patient services.
  • Emergency services.
  • Hospitalization.
  • Maternity and newborn care.
  • Mental health and substance use disorder services, including behavioral health treatment.
  • Prescription drugs.
  • Rehabilitative and Habilitative services and devices.
  • Laboratory services.
  • Preventive and wellness services and chronic disease management.
  • Pediatric services, including oral and vision care.

Health insurance companies have flexibility in determining how these benefits are covered. Health plans may cover additional services, such as chiropractic care. In addition, individuals may have the option to purchase stand-alone dental or vision care on the Marketplace.

Related FAQs:
What is Minimum Essential Coverage?
How do I purchase dental coverage?