What Is Included in Every Healthcare.gov Plan?

All Healthcare.gov plans are required to cover preventive health services 100%. Additionally, these plans are required to include 10 types of health services—called Essential Health Benefits. Keep reading to learn more about these services below.

If you need health insurance coverage through Healthcare.gov, a Special Open Enrollment Period is now open through Aug. 15, 2021.

Preventive Health Services

Preventive health services are routine health care procedures, like screenings, check-ups and counseling to prevent illness, disease and other health problems.

This means that insurance companies cannot charge you a copay or coinsurance to get this type of medical attention. For example, immunizations, children’s vision screenings, contraception and well-woman visits are free. Get specific lists of preventive services for adults, women and children.

Preventive services are free only when you get them from a doctor or other provider in your plan’s network. (A network is the facilities, providers and suppliers your health insurance company has contracted with to provide health care services.) Talk to your doctor about taking advantage of these free services to keep you and your family healthy. 

Essential Health Benefits

While most of these services won’t be free, plans will pay for at least a portion of the costs of these services.

  • 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, as well as chronic disease management
  • Children’s oral and vision care

Learn more here: https://www.healthcare.gov/coverage/what-marketplace-plans-cover/ 

Learn more about how to get covered on Healthcare.gov, or call 980-256-3782 to reach a Health Insurance Navigator for free assistance. You can leave a message with a quick question or schedule a longer phone appointment.