Although all Marketplace health plans are required to cover the ten categories of essential health benefits, insurers in many states have flexibility to modify coverage for some of the specific services within each category, subject to approval by their Marketplace. All health plans must provide consumers with a Summary of Benefits and Coverage (SBC) to make it easier for you to compare differences in health plan benefits and cost sharing. The SBC is a brief, plain-language description of what a plan covers, as well as examples of what the plan would cover in common medical situations. It is also available for each plan on the Marketplace website.

Plans might differ in other ways, too. For example, the “network” of health providers in your plan might be different from plan to plan. In addition, health plan formularies (list of covered prescription drugs) may vary considerably. Plans shown on Marketplace websites must include links to provider directories and formularies so you can check if your providers and medications are covered.