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P. 101
TAX YEAR
2019
Health Care Reform
Health Insurance Marketplace
Health Insurance Marketplace • Hospitalization (such as surgery).
• Maternity and newborn care (care before and after
The Health Insurance Marketplace helps uninsured your baby is born).
people find health coverage. When you fill out the Mar- • Mental health and substance use disorder services,
ketplace application online the website will tell you if including behavioral health treatment (this includes
you qualify for: counseling and psychotherapy).
• Private health insurance plans. The site will tell you • Prescription drugs.
whether you qualify for lower costs based on your • Rehabilitative and habilitative services and devices
household size and income. Plans cover essential (services and devices to help people with injuries, dis-
health benefits, pre-existing conditions, and preven- abilities, or chronic conditions gain or recover mental
tive care. If you don’t qualify for lower costs, you can and physical skills).
still use the Marketplace to buy insurance at the stan- • Laboratory services.
dard price. • Preventive and wellness services and chronic disease
• Medicaid and the Children’s Health Insurance Pro- management.
gram (CHIP). These programs provide coverage to • Pediatric services, including oral and vision care.
millions of families with limited income. If it looks like
you qualify, the exchange will share information with Essential health benefits are minimum requirements
your state agency and they’ll contact you. Many but for all Marketplace plans. Specific services covered in
not all states have expanded Medicaid to cover more each broad benefit category can vary based on your
people. state’s requirements. Plans may offer additional ben-
efits that are not included in essential health benefits,
If you’re eligible for job-based insurance, you can con- such as dental and vision coverage.
sider switching to a Marketplace plan, but you won’t
qualify for lower costs based on your income unless the Benefits are generally the same in each state. Howev-
job-based insurance is unaffordable or doesn’t meet er, some states require insurers to cover additional ser-
minimum requirements. You also may lose any contri- vices and procedures. When you compare plans in the
bution your employer makes to your premiums. Marketplace, you will be able to see the specific benefits
each plan offers.
What is Covered?
All private health insurance plans offered in the Mar-
ketplace offer the same set of essential health benefits.
The essential health benefits include at least the follow-
ing items and services:
• Ambulatory patient services (outpatient care you get
without being admitted to a hospital).
• Emergency services.
