What is a Health Insurance Marketplace?
A Health Insurance Marketplace is a one stop place where people can compare insurance plans, choose a plan and enroll.
All insurance plans sold in the Health Insurance Marketplace must include basic and essential health benefits:
- Outpatient care (doctor’s office visits)
- Emergency room care
- Hospitalization, including surgery
- Care before and after the birth of a baby
- Mental health and substance use disorder services, including such counseling and psychotherapy
- Prescription medications
- Services and devices to help people who are injured, disabled, or have chronic conditions. This includes physical and occupational therapy, speech language pathology, psychiatric rehabilitation, and more.
- Lab tests
- Preventive services to keep you healthy, like vaccines, screenings, counseling and chronic disease management
- Healthcare for children, including dental and eye care
Individual health insurance plans in the Marketplace can be structured differently from each other:
- Deductibles, premiums, co-pays, and co-insurance might not cost the same. For example, deductibles may be higher or lower.
- Additional benefits may be offered, or
- You may have to see certain healthcare providers or go to certain hospitals.
As an ACHD patient you need to look carefully at different policies that are offered in your state and find one that will meet your individual healthcare needs, particularly when it comes to seeing an ACHD specialist. What works for one ACHD patient may not work for another.