Each Marketplace Plan Must Offer 10 ‘Essential Benefits’

Insuring Your Health columnist Michelle Andrews helps you navigate the new insurance marketplaces that are scheduled to launch on Oct. 1.

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Q: Is there is basic package of benefits that each insurance company must offer if it is part of a marketplace?

A: To ensure that plans sold on the state-based marketplaces provide comprehensive coverage, every plan must cover 10 so-called essential health benefits. The required benefits include prescription drugs, emergency and hospital care, doctor visits, maternity and mental health services, rehabilitation and lab services, among others. In addition, recommended preventive services must be covered without any out-of-pocket costs to consumers.

If states have additional mandated benefits, for infertility treatment or autism, for example, those services will also generally be included in the plans offered through the state marketplaces. 

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