What benefits are included in a plan?

Under the Affordable Care Act (ACA), all health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, must offer a comprehensive package of items and services, known as the “essential health benefits.”

This means that all plans, regardless of the level of coverage, will generally have the same underlying benefits. Some plans might also offer additional benefits. As a consumer and advocate for your health, be sure to also consider what benefits, beyond the essential health benefits, might be important to you such as dental, vision, weight management, etc.

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Glossary

Full Glossary

Actuarial Value (AV)

The percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70%, on average, you would be responsible for 30% of the costs of all covered benefits. However, you could be responsible for a higher or lower percentage of the total costs of covered services for the year, depending on your actual healthcare needs and the terms of your insurance policy.

Affordable Care Act

The Patient Protection and Affordable Care Act (PPACA) – also known as the Affordable Care Act or ACA, and generally referred to as Obamacare – is the landmark health reform legislation passed by the 111th Congress and signed into law by President Barack Obama in March 2010. The Affordable Care Act’s main focus is on providing more Americans with access to affordable health insurance, improving the quality of healthcare and health insurance, regulating the health insurance industry, and reducing healthcare spending in the US. The law contains hundreds of different provisions that address different aspects of “the healthcare crisis” in the US.

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What benefits are included in a plan?