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10 ACA Essential Services Benefits


The "10 essential health benefits" are services that all health insurance plans must provide to comply with the Affordable Care Act. The 10 categories are:


  1. Preventive and wellness visits, including chronic disease management. Preventive care visits have no copay. Obamacare requires that all 50 procedures recommended by the U.S. Preventive Services Task Force be covered as preventive services. These include well-woman visits, domestic violence screening, and support for breastfeeding equipment and contraception.
  2. Maternity and newborn care. That must be provided without cost since it is preventive care. Most young people who don't have insurance will find this is a needed benefit if they become pregnant.
  3. Mental and behavioral health treatment. It includes treatment for alcohol, drug and other substance abuse and addiction. Insurance companies avoid paying for these diseases, which need a long-term commitment. They raise co-pays to as high as $40 a session and limit the number of therapist visits.
  4. Services and devices to help people with injuries, disabilities, or chronic conditions. Most plans cover services and equipment that help you recover from temporary injuries, like a broken leg. The ACA requires coverage for equipment needed to treat a chronic disease, like multiple sclerosis.
  5. Lab tests. Plans must pay 100 percent of the cost of tests if doctors use them to diagnose an illness. Otherwise, regular copays and deductibles apply.
  6. Pediatric care. Dental and vision care must be covered.
  7. Prescription drugs. Plans must cover at least one drug in every category in the U.S. Pharmacopeia. Your out-of-pocket drug expenses count toward your deductible. That wasn't true for all insurance plans before the ACA. They also usually offered this at a cost.
  8. Outpatient care. Most health insurance plans covered this already.
  9. Emergency Room Services. Most plans include this. Some charge extra if you go to a hospital that's out of their network, or go without pre-authorization. Obamacare plans don't charge extra.
  10. Hospitalization. Not all plans cover enough of this tremendous cost. Most people don't realize that a day in the hospital can cost between $2,000 to $20,000 a day. If you have a high-deductible plan or a one with a low maximum, you may be surprised by how much you wind up paying out-of-pocket. 

KBenefits, LLC
Christopher S. Kudryk

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