Health Insurance Brokers Raleigh, NC Share What Mandatory Coverage Affordable Care Act Plans Must Include

Many full-time workers qualify for health insurance provided by their employers. However, self-employed individuals, part-time employees, and others who don’t qualify for employer-provided health insurance must seek out their own coverage if they want to have it. 

If you need medical insurance, you may be aware that you can sort through different plans listed in the Affordable Care Marketplace (ACA), also referred to as “in the exchange.” It can be a bit daunting to understand what’s covered in every insurance plan. It can be reassuring to learn that there is certain mandatory coverage that all affordable care acts must include.

Below, our health insurance brokers in Raleigh, NC at Carolina Insurance Professionals will highlight the minimum essential health benefits insurance companies must cover so you can spend more time examining their associated in-network and out-of-network benefits, out-of-pocket obligations, co-insurance and co-pays, and deductibles that vary. 

What Minimum Essential Coverage Do All Affordable Care Act Health Insurance Plans Have?

It’s mandated that all Affordable Care Act (ACA) health plans include the following to ensure everyone, whether they have an individual or group health plan, has access to streamlined health benefits to cover these 10 essential medical services:

  • Maternity care: This includes pre-and post-natal care (before and after your child’s birth)
  • Prescription drug coverage: This may include medications needed for chronic medical conditions, such as diabetes, or perhaps an acquired illness, such as pneumonia
  • Rehabilitative devices and recovery services: Any medical devices needed to recover from an illness or injury, such as a brace to stabilize a fractured bone, or recovery services, such as physical therapy or occupational therapy, may fall into the category of mandatory coverage that your health insurance policy must include
  • Laboratory testing: This would include any lab tests ordered by your doctor, such as a blood test
  • Pediatric care: This includes treatment for physical ailments and mental health concerns of children from birth to young adulthood, as well as dental and vision care
  • Inpatient care: This refers to any medical care you may receive after being admitted to a hospital or other designated medical center
  • Outpatient care: This includes any medical treatments you may receive without being admitted to the hospital for an overnight stay, for example
  • Substance abuse and mental health treatment: Psychotherapy, more commonly known as emotional or behavioral counseling, or any services aimed at helping with addictions to prescription drugs, illegal drugs, or alcohol, may fit into this category
  • Preventative care: This category may consist of vaccines, health screenings, or health education initiatives, often called “counseling,” aimed at curbing risk factors for those pre-disposed to certain medical conditions or chronic diseases, like human immunodeficiency virus (HIV) or type II diabetes

Other Mandatory Changes Instituted With the Passing of the Affordable Care Act

Now that you’re familiar with the mandated coverage for certain types of treatment that all plans available through the marketplace must offer, let’s discuss a few more details regarding eligibility for these plans.  

Once the exchange was established not only in North Carolina but nationwide in 2015, it made it illegal for health insurance companies to deny coverage to those individuals with pre-existing conditions. In other words, they must insure individuals with conditions such as diabetes, cancer, or asthma patients, whereas insurers used to be able to get by without doing so. The establishment of the ACA marketplace also made it unlawful for insurers to charge someone more if they had previously been diagnosed with a pre-existing condition.

The ACA also restricts a health insurer from placing annual coverage caps on the mandatory, essential health benefits outlined in the previous sections, thus ensuring more benefits for a lower cost. 

Why It’s Beneficial To Work With a Health Insurance Broker To Help You Find a Plan

It can be a bit daunting navigating the healthcare marketplace. There’s an open enrollment period during which virtually everyone can select a plan. Then there’s a special enrollment period (SEP) during which individuals who have lost coverage, had a baby, gotten married, experienced a change in household income, adopted a child, or have experienced other life-changing events, may acquire health insurance. Premium subsidies, or subsidized plans, may be available to certain individuals facing financial hardship to ensure they can afford coverage. 

No matter whether you attempt to purchase insurance during an open enrollment period or because you have a qualifying event, it can be daunting to make sense of what may seem like subtle differences between the plans. Fortunately, you don’t have to go at it alone when trying to determine which coverage plan is best for you and your family. Our Raleigh, NC health insurance brokers can help. What’s more, that’s a service we can offer you free of charge! 

So, if you need health insurance, making sense of your options, and understanding how to find a plan that fits your budget, and provides the coverage you need is all made easy when you let our talented independent health insurance brokers at Carolina Insurance Professionals help you navigate the process. Call or email our independent insurance professionals for assistance now. Health insurance policies are available from all major insurers you’re likely already familiar with in the marketplace.