Individual/Families
Coverage
- Coverage available for children to stay on their parent's plan up to age 26
- Cannot be turned down for Pre-existing conditions
Care
- All health insurance plans must offer the same set of Essential Health Benefits
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- 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)
- Pediatric services
- Laboratory services
- Preventive and wellness services and chronic disease management
- Free Preventive Care List of all preventive care services
- Discounts for Seniors
- Benefits for women
- Covering Preventive Screenings
- Lower Costs
- Choice of Doctors (Within your plan)
Costs
- Insurance must justify any premium increase greater than 10%
- End Lifetime limits on coverage
- Administrative costs on premiums are capped at 20%, anything over 20% will be refunded back to the consumer (80/20 Rule)
- Beginning in January 2014, individuals under 65 years of age with income below 133 percent of the federal poverty level (FPL) will be eligible for Medicaid.