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What health plans are offered through the Marketplace?

All health plans offered through the Marketplace must meet the requirements of “qualified health plans.” This means they will cover essential health benefits, limit the amount of cost sharing (such as deductibles and co-pays) for covered benefits, and satisfy all other consumer protections required under the Affordable Care Act. Health…

What health benefits are covered under Marketplace plans?

All qualified health plans offered in the Marketplace will cover essential health benefits. Categories of essential health benefits include: Ambulatory patient services (outpatient care you get without being admitted to a hospital) Emergency services Hospitalization Maternity and newborn care (care before and after your baby is born) Mental health and…

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

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.…

How can I find out if my doctor is in a health plan’s network?

Each plan sold in the Marketplace must provide a link on the Marketplace web site to its health provider directory so consumers can find out if their health providers are included. The provider network information that insurance companies provide may or may not tell you whether a provider is accepting…

What happens if I need care from a doctor who isn’t in my plan’s network?

Plans are not required to cover any care received from a non-network provider, though some Marketplace plans do, at least to some extent. If you do receive care out of network, it could be costly to you. Generally plans that provide an out-of-network option cover such care at a lower…

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.