Health Benefits and Preventative Care Services

10 Essential Health Benefits

All private health insurance plans offered on the Health Insurance Marketplace will offer the same set of essential health benefits. These are minimum requirements but plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side on the Marketplace.

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventative and wellness services and chronic disease management
  • Pediatric services

Preventative Care Services

All Marketplace plans must cover the following list of preventive services without charging you a co-payment or coinsurance. This is true even if you haven’t met your yearly deductible and it applies only when these services are delivered by a network provider. Screenings will be available based on certain criteria and conditions.

  • Preventative screenings for all adults
  • Abdominal Aortic Aneurysm one-time screening
  • Alcohol Misuse screening and counseling
  • Aspirin use
  • Blood Pressure screening
  • Cholesterol screening
  • Colorectal Cancer screening
  • Depression screening
  • Diabetes (Type 2) screening
  • Diet counseling
  • HIV screening
  • Immunization vaccines
  • Obesity screening and counseling
  • Sexually Transmitted Infection (STI) prevention counseling
  • Syphilis screening
  • Tobacco Use screening
  • Preventative screenings for women
  • Anemia screening
  • Breast Cancer Genetic Test Counseling (BRCA)
  • Breast Cancer Mammography screenings
  • Breast Cancer Chemoprevention counseling
  • Breastfeeding comprehensive support and counseling
  • Cervical Cancer screening
  • Chlamydia Infection screening
  • Contraception
  • Domestic and interpersonal violence screening and counseling
  • Folic Acid
  • Gestational diabetes screening
  • Gonorrhea screening
  • Hepatitis B screening
  • HIV screening and counseling
  • Human Papillomavirus (HPV) DNA Test
  • Osteoporosis screening
  • Rh Incompatibility screening
  • Sexually Transmitted Infections counseling
  • Syphilis screening
  • Tobacco Use screening and interventions
  • Urinary tract or other infection screening
  • Well-woman visits
  • Preventative screenings for children
  • Autism screening
  • Behavioral assessments
  • Blood Pressure screening
  • Cervical Dysplasia screening
  • Depression screening
  • Developmental screening
  • Dyslipidemia screening
  • Fluoride Chemoprevention supplements
  • Gonorrhea preventive medication
  • Hearing screening
  • Height, Weight and Body Mass Index measurements
  • Hematocrit or Hemoglobin screening
  • Hemoglobinopathies or sickle cell screening
  • HIV screening
  • Hypothyroidism screening
  • Immunization vaccines
  • Iron supplements
  • Lead screening
  • Medical History
  • Obesity screening and counseling
  • Oral Health risk assessment
  • Phenylketonuria (PKU) screening
  • Sexually Transmitted Infection (STI) prevention counseling and screening
  • Tuberculin testing
  • Vision screening