What drugs are covered under the Affordable Care Act?
Asked by: Roman Krajcik | Last update: June 14, 2025Score: 4.6/5 (48 votes)
What is a list of drugs approved for coverage?
A formulary is a list of drugs that are covered by your health plan. Each drug in the formulary is listed alongside its tier, which you can use to find out how your plan covers the drug. The formulary also provides details on any authorizations, restrictions or limits that may apply to your coverage.
What drugs are considered preventive?
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.
What is covered by 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. Plans must offer dental coverage for children.
How do you know if prescription drugs are covered by your Obamacare plan?
What is not included in 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.
Does the Affordable Care Act cover prescription drugs?
All Marketplace plans cover prescription drugs.
What are 5 mandated benefits under the ACA?
The 10 categories of benefits in an EHB package are: 1) ambulatory patient services, 2) emergency services, 3) hospitalization, 4) maternity and newborn care, 5) mental health and substance use disorder services, 6) prescription drugs, 7) rehabilitative and habilitative services and devices, 8) lab services, 9) ...
Which of the following is not an essential health benefit 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 ...
What drugs are free under ACA?
- low-dose aspirin.
- breast cancer prevention medicines.
- fluoride.
- folic acid.
- iron supplements.
- statins.
- smoking cessation medicines.
- vaccines.
What are the protected class drugs?
Under Part D plans, six categories of drugs — known as the “six protected classes” — must cover “all or substantially all” of the drugs in those classes. These drugs include patients treated for epilepsy, mental illness, cancer, HIV-AIDS, and organ transplants.
What medications are considered maintenance?
What is a maintenance medication? Maintenance medications are prescription medications taken on a regular basis — often every day. They treat a wide range of ongoing or long-term conditions and illnesses such as high blood pressure, diabetes, allergies or asthma.
What drugs does Medicare not pay for?
- Drugs used to treat anorexia, weight loss, or weight gain. ...
- Fertility drugs.
- Drugs used for cosmetic purposes or hair growth. ...
- Drugs that are only for the relief of cold or cough symptoms.
- Drugs used to treat erectile dysfunction.
How to check if medication is covered by insurance?
Call your insurer directly to find out what is covered. Have your plan information available. The number is available on your insurance card the insurer's website, or the detailed plan description in your Marketplace account. Review any coverage materials that your plan mailed to you.
What is the 50/30 rule in the Affordable Care Act?
The Affordable Care Act's “shared responsibility” provisions (also referred to as the "employer mandate" or "play or pay") generally require that “applicable large employers” or ALEs (those with 50 or more full-time employees working at least 30 hours per week or their equivalents when adding together part-time hours) ...
What does the Affordable Care Act cover?
The ACA requires insurance plans to cover preventive care such as immunizations; preventive care for children; screening for certain adults for conditions such as high blood pressure, high cholesterol, diabetes, and cancer; and a public education campaign for oral health.
What is the 9.5 rule in Obamacare?
The 9.5% threshold for health insurance costs
The Health Reform bill established 9.5% as the amount of income used for health insurance beyond which, it would not be an affordable. This means that if you make $40K annually, the bill subsidizes health insurance premiums beyond just short of $4K.
How to get Ozempic covered by insurance?
Prior authorization: If your doctor prefers that you receive Ozempic, they may need to complete a Prior Authorization form to be reviewed and approved by your insurance company. This form will help explain the medical reason why you need Ozempic over other options.
Does the Affordable Care Act cover surgery?
10 covered benefits:
Hospitalization (like surgery and overnight stays) Pregnancy and newborn care (both before and after birth) Mental health and substance use disorder services, including behavioral health treatment, counseling, and psychotherapy. Prescription drugs.
What is the Affordable drugs Act?
The Inflation Reduction Act, also known as the lower cost prescription drug law, created the first ever annual cap on out-of-pocket drug costs for people with Medicare, capped the cost of each covered insulin at $35 per month, granted Medicare the power to directly negotiate drug prices, and made Affordable Care Act ( ...
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.