1. The Health Insurance Marketplace: Choosing a Category
  2. Essential Health Benefits for All Plans
  3. Qualifying for Lower Premiums and Out-of-Pocket Expenses
  4. Minimum Essential Coverage & Who Is Exempt
  5. Important Dates to Know

Regardless of whether you choose a Bronze, Silver, Gold or Platinum plan, certain essential health benefits must be covered and your copayments and coinsurance for them count towards your deductible. These services include:

  • Addiction treatment
  • Ambulatory patient services
  • Care for newborns and children
  • Chronic disease treatment (such as diabetes and asthma)
  • Emergency services
  • Hospitalization
  • Laboratory services
  • Maternity care
  • Mental health services
  • Occupational and physical therapy
  • Prescription drugs
  • Preventive and wellness services (such as vaccines and cancer screenings)
  • Speech-language therapy

Tip: These are minimum requirements. Many plans have additional benefits, so it’s important to look at the summary of benefits for any plan that you are considering to make sure it fits your budget and needs.

Qualifying for Lower Premiums and Out-of-Pocket Expenses

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