The Affordable Care Act (ACA), also known as Obamacare, requires all health insurance plans sold in the individual and small group markets to cover ten essential health benefits (EHBs). These benefits are meant to ensure that all Americans have access to high-quality, comprehensive health care. In Ohio, these EHBs are covered by all plans sold through the Health Insurance Marketplace and many other private health insurance plans.
- Ambulatory patient services: This covers outpatient care, including visits to a doctor's office, urgent care, and outpatient surgery.
- Emergency services: This covers emergency room visits for conditions that could be life-threatening or result in serious impairment if not treated immediately.
- Hospitalization: This covers inpatient care, including room and board, surgery, and other medically necessary services.
- Maternity and newborn care: This covers prenatal care, delivery, and postpartum care, as well as care for newborns.
- Mental health and substance use disorder services: This covers both inpatient and outpatient mental health and substance abuse treatment.
- Prescription drugs: This covers all prescription drugs that are approved by the Food and Drug Administration (FDA).
- Rehabilitative and habilitative services and devices: This covers services and devices that help people with injuries, disabilities, or chronic conditions to improve or maintain their ability to function.
- Laboratory services: This covers diagnostic tests, including blood tests, urine tests, and other lab tests.
- Preventive and wellness services and chronic disease management: This covers preventive care, such as check-ups and screenings, as well as management of chronic conditions like diabetes and asthma.
- Pediatric services, including oral and vision care: This covers dental and vision care for children under the age of 19, including routine check-ups and necessary treatments.
It's important to note that these essential health benefits are minimum requirements, and many plans may offer additional benefits. In Ohio, some health insurance plans may also cover additional services, such as chiropractic care, acupuncture, and fertility treatments.
In conclusion, the Affordable Care Act requires all health insurance plans sold in the individual and small group markets to cover ten essential health benefits. These benefits include everything from emergency services and hospitalization to mental health and substance use disorder services and prescription drugs. These benefits ensure that all Ohioans have access to high-quality, comprehensive health care.