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Three Marketplace Health Benefits: Plans Must Cover

Typically, each marketplace plan must cover essential healthcare benefits, preventative treatments, and pre-existing conditions. This is true for all program categories (all “metal degrees,” including Catastrophic strategies) and all plan types (like PPO and HMO). Starting November 1, 2021, you can sign up or renew the previous plan for 2022 to continue obtaining these benefits. Leet’s have a look at three marketplace health benefits.

1) What are the necessary healthcare benefits?

  • Essential health benefits include medical professionals’ visits, hospitalizations, pregnancy, prescriptions, and much more. Visit your Marketplace insurance company website to see a complete listing.
  •  All Marketplace plans cover these healthcare services. Specific facilities covered in each broad benefit group may vary based upon your state’s requirements.

2) Is treatment for my pre-existing medical condition covered?

  • All Marketplace insurance programs need to cover treatment and prescriptions for pre-existing medical conditions. This indicates no insurance coverage plan can refuse you, charge you more, or withhold spending on essential health services for any circumstance you had before your insurance coverage started.
  • If you’re pregnant when you enroll in Medicare program, an insurance coverage plan won’t refuse you or demand extra charges due to your pregnancy.

3) Are preventative healthcare services included with Marketplace coverage?

  • The Marketplace plans offer a set of preventive treatments, like vaccines and examination tests, which are easily accessible to you when provided by a medical professional in your plan’s network.
  • There are three groups of free preventive services available to children, women, and adults.


Marketplace health insurance can provide various other benefits, such as oral, vision, or medical management plans for specific diseases or conditions. You’ll find out precisely what each program offers when you compare different services on the insurer company site or page.

Accessing Medicare if you have Marketplace Insurance

Suppose you are eligible for Medicare (often upon turning 65). In that case, you should join as soon as possible to prevent a delay in Medicare coverage Three Marand the potential of a Medicare late enrollment penalty. This is true even if you get coverage through the Marketplace.

Once you are qualified to enroll in Part A:

At year’s end, your Marketplace plan may not renew. You and your family could lose coverage on Jan. 1.

You will not be eligible for Marketplace financial assistance for premiums or other medical costs. After reaching Medicare Part A eligibility, if you continue to receive premium assistance for your Marketplace plan, you may be required to repay all or a portion of that assistance when you file your taxes.

Drop your Marketplace coverage the day before Medicare starts to avoid overlap.

Can I choose coverage from the Marketplace instead of Medicare?

No. If you pay Medicare Part A, you can choose Marketplace coverage instead. Verify that the plans available through the Marketplace are suitable for your situation. Consider:

If you do not enroll in Medicare when first eligible, you may face a waiting period (typically age 65). There may be a monthly fee for enrolling late.

Are there fines?

If you can’t pay Medicare premiums, there are programs to help. Find cost-saving programs.

If you get Part A without a premium, you won’t get help paying your Marketplace premiums.

If you have ESRD but not Medicare, you can get a Marketplace plan. Before making this decision, research ESRD Medicare coverage.

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