Marketplace Benefits

A key component of ObamaCare is the Health Insurance Marketplace.  The ACA legislation provided several important marketplace benefits.  Many of these are common sense items that better insurance companies tried to offer but had to roll back under pricing pressures.

One big note here.  These benefits apply only to new plans purchased from an official Health Insurance Marketplace.  Some older grandfathered plans may not include all of this coverage yet, as may some plans provided by employers.

Tops on my list of marketplace benefits are preventative services.  All plans sold through the Healthcare Marketplace are required to provide some services for free and without meeting deductibles, co-pays, or coinsurance.  The actual list varies from state to state, but most include shots and vaccines for the Flu,  Hepatitis A and B, Herpes, Human Papillomavirus, Measles / Mumps / Rubella, Meningococcal (Meningitis), Pneumonia, DPT, and Chickenpox.

These benefit everyone.  Vaccines cost the insurance company less than treating the diseases, they keep you healthier and safer and help prevent the spread of disease to others.

Most plans also include a bunch of no cost screenings.  Insurance companies have sometimes been hesitant to offer these because they can lead to expensive treatments, but they’re all in your best interest.  Screenings include an aortic aneurysm check, alcohol, blood pressure, cholesterol, colorectal cancer, depression, diabetes, diet, hepatitis, HIV, lung cancer, obesity, and STDs.  Like the vaccines, these aren’t fun things to think about, but early detection can often lead to a healthier you and less cost to the insurance companies.

Pregnancy coverage used to be an expensive add on to some insurance plans if it was available at all.  Obamacare eliminated gender-related rate differences or denials, and many women’s health services are now offered without deductibles, co-pays, or coinsurance (that means free!).  Benefits include wellness visits, mammograms, care and counseling before and after a baby are born, and more.   There is some basic coverage for pediatric dental and vision coverage also.

Outpatient care is covered.  No longer can an insurance claim be denied because a procedure wasn’t performed in a hospital.  And inpatient care (in the hospital) is covered.  It seams strange, but some health plans specifically excluded hospital coverage.  I guess they counted on people not reading the fine print.  ER visits are covered although most insurers will encourage you to keep the cost down by only using the ER for true emergencies.

Lab tests and prescriptions are covered.  Note that different insurers may have guidelines and limits so check your policy.  For example, prescription drugs are usually regulated by a formulary, a list of approved drugs.  Regular deductibles, co-pays, and coinsurance will probably apply here.

 Mental health is now covered just like any other disease or condition, which is what it is.  Psychotherapy, counseling, and behavioral health are covered.  Substance abuse is covered also.  

Recovery services are an important feature that was often excluded from coverage previously.  This includes the services and assistance that you might need to recover or live with a debilitating injury or disease.  Some, but not all, forms of rehabilitation including occupational, physical therapy, and speech therapies are covered.

This list of marketplace benefits is just a guide and specific coverage may vary by state and policy.  Be sure to check out different plans for coverage if you have a specific need.  Remember that pre-existing conditions are covered, so you can change plans annually during open enrollment.