The Health Care Law’s 10 Essential Benefits

Health care benefits will be greatly expanded for the 55 million Americans without health coverage, along with millions who are underinsured, through President Obama’s Affordable Care Act which goes into effect on January 1, 2014.  Prior to this law’s passage, we were seeing a cutting of benefits included in a plan to lower premiums.  However, the reduction in benefits has meant a lack of true health insurance, a big disadvantage to many.

This is great news for those ages 50-64 – especially the 9 million uninsured in this age group, as well as the 4 million who buy health insurance personally.  Most current plans do not provide the 10 essential benefits.  Many of these benefits will be available for purchase, effective October 2013.  These are the essential benefits you want to be sure are included in your plan.

  1. Ambulatory Patient Services, often referred to as outpatient care.
  2. Prescriptions Drugs, meaning at least one drug in every category and class will be included and count towards any out-of-pocket caps.
  3. Emergency Care, already covered under most, will now cannot require any preauthorization nor can you be charged extra of an out-of-network visit.
  4. Mental Health Services, usually not included now, but must be covered under the new law.
  5. Hospitalization, now must be covered although you may have to pay a portion of the bill.
  6. Rehabilitative and Habilitative Services.  While most plans currently cover rehabilitative services, most do not cover habilitative services and this will change with the new law.
  7. Preventative and Wellness Services. The new law requires insurers to cover all of the 50 preventative services recommended by the US Preventive Services Task Force at no charge.
  8. Laboratory Services.  All preventative screening tests would be covered but you may still be billed for some diagnostic-type testing.
  9. Pediatric Care.  The new law would allow children under age 19 to receive teeth cleanings twice a year, x-rays, fillings and medically necessary orthodontia along with an eye exam and one pair of glasses or set of contact lenses per year.
  10. Maternity and Newborn Care.  This care would be provided at no additional cost.

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