10 Essential Benefits

The Obamacare Facts – 10 Essential Benefits

Chart of the 10 Essential Benefits in the Affordable Care Act

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10 Essential Benefits

The 10 Essential Benefits are maternity care, hospitalization, rehabilitative and habilitative services, laboratory services, pediatric services, prescription drugs, mental and behavioral health treatment, ambulatory patient services, preventive and wellness services, and emergency services.  Check to ensure your major medical health plan at work is a QHP (Qualified Health Plan) that provides these 10 Essential Benefits.

In overview, everyone must have health insurance by Jan. 1 as the most sweeping piece of federal health care reform kicks in; those who do not purchase health insurance face penalties unless they fit a narrow category of exemptions. Each plan sold on the FFM (Federally Facilitated Marketplace) or any State Exchange will carry the 10 Essential Benefits noted below. The costs of the plans will vary — both in terms of the policy premiums and in the amounts of co-pays and deductibles. The specifics of the plans may not be available until Oct. 1, when enrollment begins. Benefits start Jan. 1:

■ Ambulatory patient services: Outpatient care that includes visits to primary care doctors, home health care services and hospice care (some carriers might limit this to no more than 45 days).
■ Emergency service: Visits to the emergency room and ambulance transportation.
■ Hospitalization: Surgeries, transplants and care in a skilled nursing facility, though some carriers may limit the latter to no more than 45 days.
■ Maternity and newborn care: Prenatal care, delivery and postnatal care.
■ In-patient and out-patient mental health and substance abuse services: Some carriers may limit this to 20 days each per year.
■ Prescription drugs: Includes commonly prescribed drugs and specialty drugs, a class known for its extraordinary high cost per dosage.
■ Rehabilitative and habilitative services and devices: Allows 30 visits per year for either physical therapy, occupational therapy or chiropractor services, 30 visits for speech therapy and 30 visits for cardiac or pulmonary rehab.
■ Laboratory services: X-rays and CT scans and breast cancer diagnosis tests.
■ Preventive and wellness services: Chronic disease management and immunizations.
■ Pediatric services: Oral and vision care and more.

Where to get more information about the 10 Essential Benefits:  www.healthcare.gov

 

 

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10 Essential Benefits

Obamacare Facts

10 Essential Benefits

ACA

10 Essential Benefits

Obamacare

10 Essential Benefits