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All offered plans must have ten identified essential benefits.They are:
1. Outpatient care (sometimes called ambulatory patient services)
2. Emergency room services
4. Newborn baby and maternity care
5. Addiction treatment and mental health care
6. Prescription Drugs
7. Rehabilitative services and devices
8. Laboratory services
9. Wellness services, preventive services, and chronic disease treatment
10. Pediatric services
All plans sold in individual and small group arenas, including those sold off and on the state marketplaces, and government plans like Medicare and Medicaid hold the ten essential benefits. Some benefits, such as wellness check-ups, have no out-of-pocket expenses.
There are no annual dollar restrictions on Essential Benefits. This is so that treatments and programs will be completed thoroughly and not abandoned before the treatment is finished due to cost issues. There is a ceiling on costs that might be relative to out of pocket Essential Benefits. The plans with the ten components must cover at the minimum 60% of the expenses. Most of the plans are on a Bronze (60% average), Silver (70% average), Gold (80% average), or Platinum (90% of average) platform.
Consider plans, expenses, types of insurance, providers of insurance, your current caregiver, networks, and the different benefits of different plans.