Marketplace Health Plans and Premiums

Will covered benefits under all Marketplace plans be the same? How can I compare?

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Not necessarily. All Marketplace health plans are required to cover the ten categories of essential health benefits. However, insurers in many states will have flexibility to modify coverage for some of the specific services within each category. Any modifications must be approved by the Marketplace before plans can be offered.  All health plans must provide consumers with a Summary of Benefits and Coverage (SBC). This is a brief, understandable description of what a plan covers and how it works. The SBC will also be posted for each plan on the Marketplace web site. The SBC will make it easier for you to compare differences in health plan benefits and cost sharing.

Plans might differ in other ways, too. For example, the network of health providers 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 to see which providers and medications are covered.

While we have made every effort to provide accurate information in these FAQs, people should contact the health insurance Marketplace or Medicaid agency in their state for guidance on their specific circumstances.

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