What are the essential health benefits of Obamacare?
Asked by: Erich Wolff | Last update: July 21, 2025Score: 4.8/5 (72 votes)
What are the 10 essential health benefits under the Affordable Care Act?
- Ambulatory patient services (outpatient services)
- Emergency services.
- Hospitalization.
- Maternity and newborn care.
- Mental health and substance use disorder services, including behavioral health treatment.
- Prescription drugs.
Who determines essential health benefits?
The details of the essential health benefits package will be determined by the Secretary of Health and Human Services in a future regulation. 1 The law, however, establishes a set of mandated benefit categories and describes which plans will be required to offer the essential health benefits.
What is not covered under the Affordable Care Act?
What Benefits Does the Affordable Care Act Not Cover? The Affordable Care Act does leave two forms of insurance for adults out of its provisions — vision insurance and dental coverage. Although both of these services are considered essential benefits for children under the ACA, they are not included for adults.
Which is not an essential benefit covered under the Affordable Care Act?
Pursuant to 45 CFR 156.115(d), the following benefits are excluded from EHB even though an EHB-benchmark plan may cover them: routine non-pediatric dental services (for plan years beginning on or before January 1, 2026), routine non-pediatric dental services, routine non-pediatric eye exam services, long-term/custodial ...
Obamacare's 'essential benefits' explained
What are non-essential health benefits?
Examples of non-essential benefits might include: Chiropractic muscle manipulation. Diabetes management education. Orthotics.
Does Obamacare cover surgery?
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)
What is considered a preexisting condition?
A “pre-existing condition” is a health condition that exists before someone applies for or enrolls in a new health insurance policy. Insurers generally define what constitutes a pre-existing condition. Some are obvious, like currently having heart disease or cancer.
What is the biggest problem with the Affordable Care Act?
Impact on Individual Insurance
It was also known that consumers would face a very different health insurance world under the ACA, with some people seeing their premiums go down and some seeing them go up, and the majority of Americans seeing higher deductibles, higher copays, and a smaller pool of providers.
How much is Obamacare a month for a single person?
Monthly premiums for Affordable Care Act (ACA) Marketplace plans vary by state and can be reduced by premium tax credits. The average national monthly health insurance cost for one person on an Affordable Care Act (ACA) plan without premium tax credits in 2024 is $477.
What are the disadvantages of Obamacare?
- The cost has not decreased for everyone. Those who do not qualify for subsidies may find marketplace health insurance plans unaffordable. ...
- Loss of company-sponsored health plans. ...
- Tax penalties. ...
- Shrinking networks. ...
- Shopping for coverage can be complicated.
Does Obama Care cover prescriptions?
All Marketplace plans cover prescription drugs.
How to get a healthy benefits card?
If you haven't received a Healthy Benefits+ card, please call Healthy Benefits+ at 1-833-862-8276 (TTY users call 711) or the customer service number on the back of your UCare member ID card to request one.
Does Obamacare cover an ambulance?
Emergency services: Generally, this includes trips to the emergency room that are made necessary by an accident or sudden illness. Any transportation by ambulance must also be covered. Under the ACA, you cannot be penalized for going out of network or for not getting prior authorization for emergency care.
How much does a 3 day stay in the hospital cost?
It's easy to underestimate how much medical care can cost: Fixing a broken leg can cost up to $7,500. The average cost of a 3-day hospital stay is around $30,000.
What is covered under Obamacare?
A set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors' services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover more services.
Is there a dollar limit on essential health benefits?
Insurance companies can no longer set a dollar limit on what they spend on essential health benefits for your care during the entire time you're enrolled in that plan.
What is covered under Obamacare Silver plan?
Benefits of Silver Healthcare Plans
Hospitalization (surgery and overnight stays) Pregnancy, maternity, and newborn care. Mental health and substance use disorder services, including behavioral health treatment (includes counseling and psychotherapy) Prescription drugs.
Which of the following is not an essential health benefit?
Which of the following is NOT an essential health benefit found in qualified health plans? Qualified health plans (QHPs) must offer essential health benefits such as emergency, rehabilitative and pediatric services. Dental services are not included in the list of essential health benefits.
Who is not eligible for Obamacare?
Must live in the United States. Must be a U.S. citizen or national (or be lawfully present). Learn about eligible immigration statuses. Cannot be incarcerated in prison or jail.
Can I refuse health insurance from my employer and get Obamacare?
Obamacare is available to everyone, whether or not their employers offer insurance. From a practical standpoint, though, there are financial consequences to doing this. Often, an employer subsidizes part or all of their employees' coverage.