In three weeks, the Texas health insurance marketplace will be open for business. There will be a variety of plans to choose from 鈥� the basic bronze and even platinum 鈥� but all of them, and many private insurance plans too 鈥� will be required to cover certain benefits like checkups starting in 2014. As part of 四虎影院鈥檚 series, 鈥淥bamacare 101,鈥� we get the breakdown from Stacey Pogue of the, an Austin-based nonprofit.
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鈥淓ssential health benefits are a core set of services that cover 10 broad categories [see below], like hospitalization, doctors鈥� visits, and prescription drugs,鈥� Pogue says. These benefits may still be subject to a copay or coinsurance, or you might have to meet your deductible first, Pogue says, 鈥淏ut you鈥檙e not going to find fine print later that says you aren鈥檛 covered when you鈥檙e in the hospital or for an emergency.鈥�
Any plan offered in on the Texas health insurance marketplace must include a standard set of benefits across 10 categories. These are:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital, like routine doctor鈥檚 office visits)
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including vision care.
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