Essential Health Benefits Required by the ACA
The Affordable Care Act, or ACA, spells out federal requirements for health care to make sure every American has access to affordable health care. The ACA enforces employer standards for health care as well as medicaid requirements (and a whole lot of other rules!) The ACA has released ten “essential health benefits” that ensure that each healthcare plan covers the essential needs of an individual or family. Here is what the ACA deems essential health benefits:
- Ambulatory patient services: This means outpatient services you can receive without being admitted to a hospital including office visits, diagnostic tests, and treatments (along with many other services)
- Emergency Services: As the name suggests, this includes anything that requires emergency attention such as an emergency room visit from sudden onset pain.
- Hospitalization: This is anytime you’re admitted to the hospital for observation, surgery, or any other treatments.
- Pregnancy, Maternity, and Newborn Care: This includes prenatal care, necessary ultrasounds, birth, postpartum care, and newborn care after birth.
- Mental Health, Behavioral Health, and Substance Abuse Disorder: Including outpatient and inpatient psychological care, behavioral therapy, depression and anxiety screening, behavioral assessments, rehabilitation therapy, and more.
- Prescription Drug Coverage
- Rehabilitative and Habilitative services and Mobility Devices: Physical therapy, occupational therapy, walkers, wheelchairs, crutches, canes, and more.
- Laboratory and Diagnostic Testing
- Preventative and Wellness Care and Chronic Illness Management: Well child visits, physicals, well woman exams, routine blood work, pain management, routine follow ups, and many other services.
- Pediatric services, including oral and vision care: This does not include adult vision and oral care.
Every plan will have different coverages, but these are the bare minimum that they must include to some degree. Look into your specific plan to determine how much is covered for you and your family. If you need better coverage (or you don’t have coverage at all) contact Sean the Insurance Guy to get started today with a free consultation!