Get information about basic health benefits, pre-existing conditions, and preventive care

published to September 12, 2019

All Marketplace plans cover basic health benefits, pre-existing conditions, and preventive care. This is true for all plan categories (all “metal tiers” including catastrophic plans) and all plan types (HMO, PPO, etc.). Beginning November 1, 2019, you can still take advantage of these benefits by enrolling or renewing your 2020 plan.

What are the essential health benefits?

  • Basic health benefits cover doctor visits, prescriptions, hospitalization, pregnancy, and more. See full list.
  • These benefits are covered by all Marketplace plans. The specific services covered by each broad benefit category may vary depending on state requirements.

Will my pre-existing medical treatment be covered?

  • All Marketplace plans must cover the following treatments pre-existing medical conditionsThis means that no insurance plan can deny you enrollment, charge additional fees, or refuse to pay essential health insurance for conditions you had before coverage began.
  • If you are pregnant at the time of your application, your insurance plan cannot deny your application or charge you additional fees because of your pregnancy.

Are preventive health services included in Marketplace coverage?

  • Marketplace plans cover a range of preventive services, such as immunizations and screening tests, and are free when provided by a doctor within the plan’s network.
  • There are 3 sets of free prevention services for adults, women, and children. Check out the list here.

Note: Health insurance can provide other benefits, such as vision, dental, or medical management programs for certain illnesses or conditions. Compare on to see exactly what each plan offers.

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