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Affordable Care Act: 10 Essential Benefits

All plans offered in the Marketplace cover the same set of essential health benefits. They are:

  1. Ambulatory patient services (outpatient care you get without being admitted to a hospital)

  2. Emergency services

  3. Hospitalization (like surgery and overnight stays)

  4. Pregnancy, maternity, and newborn care (both before and after birth)

  5. Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)

  6. Prescription drugs

  7. 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)

  8. Laboratory services

  9. Preventive and wellness services and chronic disease management

  10. Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

The level of coverage for these services can vary. All the plans in the marketplace must provide consumers with a brief, understandable description of what they cover and how their plan works. To answer any additional questions regarding the Health Insurance Marketplace or to make an appointment with a Certified Navigator, please contact the Health Council of South Florida at 786-708-0836 or text "ACA HELP" to 41411.



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