All plans offered in the Marketplace cover the same set of essential plan benefits. Here is a list of the 10 categories of services health insurance plans must cover:
1. Ambulatory patient services (also known as outpatient care, such as a visit to your primary care doctor or a specialist)
2. Emergency services
3. Hospital care (like surgery and overnight stays)
4. Pregnancy, maternity, and newborn care (before and after birth)
5. Mental health and substance use services (including behavioral health treatment)
6. Prescription drugs
7. 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)
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care (but please note: adult dental and vision coverage aren’t essential health benefits)
Note: All insurance plans listed on our site are ACA compliant! This means all plans a member sees on Stride will cover these 10 Essential Health Benefits.
Interested in finding out more about birth control coverage? Please feel free to check out this handy resource: Is birth control covered? Is it free?
Under the Affordable Care Act, most Marketplace plans must provide breastfeeding support, counseling, and equipment (including the cost of a breast pump). These services may be provided before and after birth.
If you have more questions about what is covered under a specific health plan, we recommend you first look at the plan’s Summary of Benefits and Coverage. The Summary of Benefits and Coverage (SBC) is an easy-to-read summary that lets you compare the different features of health benefits and coverage. The SBC contains a snapshot of a health plan’s cost, benefits, covered health services, and other features that are important to know.
Note: You can find a link to a health plan’s SBC by clicking the “Details” button when reviewing available health plans on Stride. When you select one of the coverage detail categories (from 'Prescription Drugs' down through 'Out-of-network coverage'), there’s a dropdown that’ll read “Need even more info? View the full summary of coverage” when the SBC is available. If there isn’t a link, you can check the carrier’s website or even input “[plan name] + Summary of Benefits and Coverage” into your favorite search engine.
Feel free to browse through some of the health plans available in your area now! Click here.