Health insurance plans must cover 10 categories of services under the Affordable Care Act 2022. These include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover more services.
Plans must offer dental coverage for children. Dental benefits for adults are optional. Specific services may vary based on your state’s requirements. You will see exactly what each plan offers when you compare plans.
Essential Health Benefits Of The Affordable Care Act 2022
Important Health Benefits Of the Affordable Care Act 2022 include the following services and more.
- Doctors’ services
- Inpatient and outpatient hospital care
- Prescription drug coverage
- Pregnancy and childbirth
- Mental health services
- Ambulatory patient services
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
Additional Benefits Of The Affordable Care Act 2022:
Your health insurance does not have to offer dental care for adults. However, insurers must provide dental coverage for children. If you buy insurance through the Marketplace, this may be part of your regular health plan.
Or you may have to buy a stand-alone dental procedure if you want coverage for your children. It’s up to the states to decide whether to require parents to purchase these plans for their children.
You will find the same limits on vision care as on dental care. Insurance companies don’t have to offer vision coverage for adults, but they do for children. In some states, you might have to buy a stand-alone vision plan to cover your children.
Home health care:
All states include home health care in their definition of essential health benefits. Home care may be subject to limits on the number of visits.
You will need to pay for long-term care if you become disabled or move to a nursing home. It’s not an essential health benefit under the affordable care act and is not covered by Medicare or most private health plans.
How Much Coverage People Got For These Essential Health Benefits
The Affordable Care 2022 Act’s requirement that essential health benefits be covered without annual dollar caps provides patients with more health benefits and a lesser financial burden.
While plans before the Affordable Care Act 2022 stated that they covered many of these services. Actual coverage was often uneven patients faced unexpected dollar limits on services that were technically covered by their plans, forcing them to pay the remainder of costs.
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Additionally, this new definition of coverage enshrined in the Affordable Care 2022 ensures that plans cover important services that are not currently covered by many plans:
- People with mental health or substance abuse disorders will have the peace of mind of knowing that their plan must cover their needs. Their coverage for these mental health services must be as comprehensive as their coverage for medical and surgical services.
- Women can rest assured knowing that they will have maternity coverage when they become pregnant.
- People with developmental and intellectual disorders will benefit from habilitative services that help them learn, keep, or improve functional skills when most plans now will only cover services to regain skills.
One popular aspect of the Affordable Care Act 2022 is its requirement that all individual and small group health plans (for people who don’t have traditional job-based coverage) cover important health benefits like maternity, mental health, preventive, and pediatric dental care.
Members of Congress and the Trump administration have frequently proposed measures that would eliminate or undermine these essential health benefits (EHBs), as they are known.
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