Traditional Health Insurance

A "qualified" major medical health plan is an insurance plan that’s certified by the Health Insurance Marketplace, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements under the Affordable Care Act.  All qualified health plans meet the Affordable Care Act requirement for having health coverage, known as minimum essential coverage.”

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Did You Know
What are the 10 "essential health benefits"
What does "minimum essential coverage" mean?
When Can I Enroll?
Did You Know

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What are the 10 "essential health benefits"

All plans offered in the Marketplace 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)

    Additional benefits
  • Plans must also include the following benefits:
  • Birth control coverage
  • Breastfeeding coverage
  • Essential health benefits are minimum requirements for all Marketplace plans. Specific services covered in each broad benefit category can vary based on your state’s requirements. Plans may offer additional benefits, including:
  • Dental coverage
  • Vision coverage
  • Medical management programs (for specific needs like weight management, back pain, and diabetes).
What does "minimum essential coverage" mean?

Examples of qualifying health coverage

See a more detailed list of types of plans that do and don’t count as qualifying health coverage from the IRS.

When Can I Enroll?

Open Enrollment is November 1st - December 15th each year.

You can still get coverage outside of Open Enrollment in 2 ways:

SEE IF YOU CAN GET COVERAGE

If you don't have the need for expensive comprehensive coverage.  Take a look at some of these alternative options, clients are saving THOUSANDS of dollars a year!

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