Health insurance benefits explained: Essential health benefits

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All marketplace plans cover these 5 essential health benefits.



So it looks like 2020 is finally coming to an end. I am sure there were many things you planned to do this year that never happened. See the world, spend more time with family, take up knitting, and so on. You, at the very least, signed up for health insurance, right?


Well, if you did not, you may still be able to. But if you did, then good job! Next year will be the year we put all that's wrong and broken in the world back together again. That's the plan, at least, we hope.


If you are like me, being cooped up at home and listening to Dolley Parton's When Life Is Good Again, over and over again.




You are probably making all kinds of promises to yourself and your loved ones. One of my promises/new year's resolutions is to take my health more seriously.


Seriously, I plan to undergo a complete, head-to-toe transformation in 2021. I plan to run more, eat healthier, and get regular health checkups. Lord knows it's been a while.




Which leads me to the point of this article. As a newly-minted enrollee in a marketplace (Obamacare) health plan, it pays to know what your plan covers (for free). That being said:




All marketplace plans cover these 5 essential health benefits:


1. Blood pressure screening


One in 3 American adults have high blood pressure. High blood pressure increases your risk for serious health problems, including stroke and heart attack.


Get your blood pressure checked regularly starting at age 18 – and do your best to keep track of your blood pressure numbers.



2. Mental health & substance abuse coverage


All plans must cover:


  • Behavioral health treatment, such as psychotherapy and counseling

  • Mental and behavioral health inpatient services

  • Substance use disorder (commonly known as substance abuse) treatment


3. Birth control benefits


Covered contraceptive methods


FDA-approved contraceptive methods prescribed by a woman’s doctor are covered, including:


  • Barrier methods, like diaphragms and sponges

  • Hormonal methods, like birth control pills and vaginal rings

  • Implanted devices, like intrauterine devices (IUDs)

  • Emergency contraception, like Plan B® and ella®

  • Sterilization procedures

  • Patient education and counseling


Plans aren’t required to cover drugs to induce abortions and services for male reproductive capacity, like vasectomies.



4. Cervical cancer screening

  • Pap test (also called a Pap smear) every 3 years for women 21 to 65

  • Human Papillomavirus (HPV) DNA test with the combination of a Pap smear every 5 years for women 30 to 65 who don’t want a Pap smear every 3 years


5. Preventive and Wellness Services and Chronic Disease Management


Includes services such as :


  • Diet counseling for adults at higher risk for chronic disease

  • Anemia screening on a routine basis

  • Urinary tract or other infection screening

  • Immunization vaccines for adults — doses, recommended ages, and recommended populations vary



Want to know more about essential health benefits and which ones are covered under your plan? Click here.

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