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Affordable Care Act Plans from the Marketplace

State-based, guaranteed issue coverage

Woman & Doctor

More Options To Meet Your Needs

Everyone deserves access to affordable, quality health care coverage and services. With the Affordable Care Act (ACA), four out of five qualified people can find a plan for $10 or less per month, due to newly expanded financial assistance programs. Additionally, there are more coverage options than previous seasons, with the average consumer being able to choose between four insurance companies with plan options. Your Commonwealth Insurance Partners Benefits Advisor can assist you to make the best choice for your circumstances.

The 10 Essentials of All Plans for Individuals & Families with Public Exchange Insurance

All plans offered in the Marketplace (including states’ versions) cover these 10 essential health benefits:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)

  • 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)

Kids Doctor Checkup

Pre-Existing Condition(s)

This is a health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts. Insurance companies can’t refuse to cover treatment for your pre-existing condition or charge you more.

X-Ray Results

Additional benefits

Plans must also include the following benefits:

 

Specific services covered in each broad benefit category can vary based on your state’s requirements. Plans may offer additional benefits, including:

Vision Coverage

This is a health benefit that at least partially covers vision care, like eye exams and glasses. All plans in the Health Insurance Marketplace® include vision coverage for children. Only some plans include vision coverage for adults.

If adult vision coverage is important to you, check the details of any plan you’re considering.

 

If your plan doesn’t include adult vision coverage, you can buy a “stand-alone” vision plan to reduce your vision care expenses. The Marketplace doesn’t offer stand-alone vision plans. To shop for stand-alone vision plans, you can do so yourself or contact your CIP Benefits Advisor for assistance. You can also contact your state’s Department of Insurance.

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