ObamaCare Unlocked: The Affordable Care Act’s 10 Essential Benefits

Have you, or someone you know, ever had a health condition that required a trip to the doctor, only to be told that your health insurance policy didn’t cover it?

Many Americans have been shocked to have just that experience, finding out after the fact that they weren’t as protected by their health insurance as they thought they were.

Well, the Affordable Care Act will change that. Starting on January 1, 2014, all new small group and individual health plans sold in the United States must cover the following 10 essential health benefits in order to meet the criteria for Qualified Health Plans under the Affordable Care Act:

  1. Ambulatory Patient Services – This is a fancy way to say outpatient care, or any regular visit to the doctor.
  2. Hospitalization – you’re also covered for inpatient care, which is when your treatment requires hospitalization.
  3. Emergency Services – Trips to the emergency room are also covered.
  4. Maternity & Newborn Care – For pregnant women, the Affordable Care Act mandates care before and after your baby is born.
  5. Mental Health Services – This includes substance abuse treatment, as well as counseling and psychotherapy.
  6. Prescription Drugs – Every plan must cover at least drug in each class and category of the U.S. Pharmacopeia, the list of approved medication in the United States.
  7. Rehabilitative and Habilitative Services – This basically includes services and devices that will aid in your recovery if you are injured, if you have a disability or if you suffer from a chronic condition.
  8. Laboratory Services – Your lab tests are covered.
  9. Preventive and Wellness Services – This includes all 50 preventive services recommended by the United States Preventive Services Task Force. These services will be provided for free to the insured, and are expected to help lower future health care costs as people receive help and support to make healthier choices before they turn into health problems.
  10. Pediatric Care – The big news here is that the Affordable Care Act mandates dental and eye care coverage for children under the age of 19, which many current plans don’t include.

Although these 10 essential health benefits will be covered by every plan under the ACA, the cost to the insured will vary based on the level of plan purchased. And each state has a certain amount of leeway to interpret the exact meaning of each benefit and how they will cover it. To find out exactly what this means for you where you live, visit the Health Insurance Exchange for your state.