The 10 Essential Benefits Guaranteed by Insurance Plans in the ACA Health Care Marketplace

The 10 Essential Benefits Guaranteed by Insurance Plans in the ACA Health Care Marketplace

The Affordable Care Act (ACA) Health Care Marketplace ensures that all health insurance plans offer ten essential benefits to their enrollees. These benefits aim to provide comprehensive coverage for various medical services and treatments. Firstly, ambulatory patient services are an essential benefit of health insurance plans in the ACA Health Care Marketplace (Kates et al., 2021). This includes services provided in a doctor’s office, outpatient clinic, or another setting. It covers preventive services, diagnostic tests, and other medical services that do not require admission to a hospital. Secondly, emergency services are another essential benefit. It includes care for medical conditions that require immediate attention, such as a heart attack or stroke. Insurance plans must cover emergency services, regardless of whether the healthcare provider is in or out of the plan’s network. Thirdly, hospitalization is an essential benefit that covers the cost of inpatient care, including room and board and other necessary medical services (Yabroff et al., 2019). This benefit also includes surgery, anesthesia, and other treatments that require hospital admission. Fourthly, maternity and newborn care is a benefit that provides coverage for prenatal care, childbirth, and postpartum care. This benefit also covers newborn care, such as routine newborn screening tests and preventive services. Fifthly, mental health and substance use disorder services are essential benefits that provide coverage for mental health treatment and substance use disorder treatment. This includes counselling, psychotherapy, and medication-assisted treatment for substance use disorders.

Sixthly, prescription drugs are an essential benefit that covers the cost of prescription drugs, including those used to treat chronic conditions. Insurance plans must cover at least one medication in each drug category, and the formulary must include drugs considered essential for treating common conditions. Seventhly, rehabilitative and habilitative services and devices are essential benefits that provide coverage for services and devices that help individuals recover from injuries or illnesses (Jones et al., 2020). This includes physical therapy, occupational therapy, and speech therapy. Eighthly, laboratory services are an essential benefit that covers the cost of lab tests, including blood tests, urine tests, and other diagnostic tests. Ninthly, preventive and wellness services and chronic disease management are essential benefits that provide coverage for preventive care, such as annual check-ups, vaccinations, and cancer screenings (Jiang et al., 2018). It also includes chronic disease management for conditions such as diabetes and asthma. Lastly, pediatric services, including oral and vision care, are essential benefits that provide coverage for preventive and routine care for children. This includes dental and vision care, immunizations, and other preventive services. The ACA Health Care Marketplace ensures that all health insurance plans offer these ten essential benefits. These benefits provide comprehensive coverage for various medical services and treatments and ensure that individuals can access the care they need to maintain their health and well-being.

Successes of the Affordable Care Act (ACA)

Increased Access to Healthcare Coverage

One of the primary successes of the Affordable Care Act (ACA) is that it has significantly increased access to healthcare coverage for millions of Americans. Before the ACA, many individuals could not obtain health insurance due to pre-existing conditions, high costs, or simply not having access to employer-sponsored coverage (Rice et al., 2018). The ACA addressed these issues by establishing state-based health insurance marketplaces where individuals can purchase affordable health insurance plans that meet their needs. Additionally, the ACA expanded Medicaid coverage to include more individuals and families, providing them access to preventive care, doctor visits, and prescription drugs. As a result, millions of previously uninsured Americans can now access the healthcare they need to maintain their health and well-being.

Lowered Uninsured Rates

Another significant success of the ACA is the significant reduction in uninsured rates. Before the ACA, millions of Americans were uninsured, leaving them vulnerable to catastrophic healthcare costs and unable to access essential healthcare services (Blumenthal et al., 2020). With the implementation of the ACA, the uninsured rate in the United States has dropped to historic lows. This is primarily due to Medicaid’s expansion and the health insurance marketplaces’ establishment. By providing affordable health insurance options to those who previously could not afford coverage,