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Three benefits Marketplace health 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.

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.

Note:

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.

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