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essential health benefits
Approximately seven million Americans have enrolled in public health insurance since the Affordable Care Act was initiated in 2013. Through the recently revamped Health Insurance Marketplace, nearly one million more Americans have gained health coverage since Thanksgiving.
As the end of 2014 approaches and important deadlines creep closer, we've provided ten things consumers should know about the Health Insurance Marketplace for 2015.
- United States' citizens, lawful nationals, and immigrants with an approved status are eligible to shop for health insurance using the Health Insurance Marketplace.
- The last day to enroll in Marketplace coverage that will begin as soon as January 1, 2015, is December 15, 2014. February 15, 2015, is the last day to sign up for public health insurance for 2015. Grace periods may be approved in rare circumstances (check here after January 1st). Members of federally recognized tribes or Alaska Native Claims Settlement Act Corporation (ANCSA) shareholders may enroll in Marketplace coverage any time of the year.
- Alas! Public health plans purchased through the Health Insurance Marketplace do not deny coverage based on pre-existing conditions.
- Marketplace insurance plans are parity protected. What does "parity protected" mean?
- Financial requirements for mental health services must be equal to or lesser than those required for most medical services. For example, you cannot be charged a co-payment of $40 for an office visit to a psychologist and $20 for an office visit to a medical doctor if the sum cost for all of your used medical services totals less than $40.
- Insurers cannot put a firm limit on the number of treatment sessions that are covered in a health plan. Care is evaluated on a case-by-case basis for "medical necessity" according to criteria established by treatment and insurance providers.
- A single deductible now applies to both mental health treatment services and medical treatment services. Prior to the parity law, insurance plans could require patients to meet different deductibles for mental health services and medical services. A deductible is the overall amount patients pay out-of-pocket per year before health insurance makes any payments.
- More good news for mental health! All insurance plans purchased through the Health Insurance Marketplace include mental health and substance use disorder services as an essential health benefit. An essential health benefit is part of a comprehensive package of services that must be covered in a health plan. In the individual and small group markets, both inside and outside of the Health Insurance Marketplace, essential health benefits are guaranteed.
- The other 9 essential health benefits: ambulatory services (outpatient services you can get without being admitted to a hospital); emergency services; hospitalization (e.g., surgery); pregnancy, maternity and newborn services (e.g., neonatal care); prescription drug services; rehabilitative services; laboratory services (e.g., HIV testing, blood work); preventative and wellness services (e.g., screening for alcohol misuse, blood pressure, depression, diet, tobacco use, etc.); and pediatric services (i.e., primary care for children).
- You may be eligible for savings on Marketplace health insurance depending on your income and household size. Individuals with annual incomes below $46,680, and families of four with incomes below $95,400, will generally qualify for savings. This chart will guide you in discovering if you or your family qualify for low-cost health coverage. Children may be enrolled in their parents' health plans, inside or outside of the Health Insurance Marketplace, until age 26.
- The Marketplace Call Center is open 24 hours a day, 7 days a week. Call to start an application, seek help completing an application, compare health plans, or ask a question.
- Click here to browse Marketplace insurance options for 2015. Enter your United States zip code and you will be taken to the unique "shopping site" for your home state. Before electing to enroll in a health plan, be sure to have all necessary documents prepared and gathered.
- For personalized, local help: Try here.
Learn more about insurance and the Affordable Care Act in our Learning Center.