Health Care Reform 101: Essential Health Benefits

Health Care Reform 101: Essential Health Benefits


As part of health care
reform, all individual plans have to cover 10
essential health benefits. Yes, I remember that. Their purpose is to make sure
that no matter which plan or which insurance
company you choose, you get basic coverage
for day-to-day sickness, chronic conditions,
and major surgery. All right. And remind me, what
are the 10 benefits? Well, there’s ambulatory
patient services. And what’s that? Outpatient stuff? Yeah, outpatient services,
procedures, tests, that sort of thing. Good, got it. Then there’s emergency services,
hospitalization, maternity and newborn care, mental
health and substance use disorder services, including
behavioral health treatment. OK. That’s five. Prescription drugs. Six. Rehabilitative
services and devices, in other words, something
you might need short term while you recover
from an injury. Uh-huh. Lab services, preventive
and wellness services, and chronic disease management. And number 10? Number 10 is pediatric services,
including oral and vision care for anyone up to age 19. OK. That’s a pretty solid list. All plans also have to
limit how much you pay out of pocket during the year. To how much? For individuals, the
upper limit is $6,350. For families, it can’t
be more than $12,700. That seems kind of
high, doesn’t it? But that’s the
worst case scenario, the most anyone
could possibly pay. For most people, it
will be lower than that, maybe a lot lower. And all of your
out-of-pocket expenses are applied to this amount. Which means what? Deductibles, co-pays? That means your
deductibles, your co-pays, coinsurance, even
your drug co-pays. They all apply to that total. So no matter what, your
out-of-pocket expenses are capped? Yes, and anything
over that amount is 100% covered
by your insurance. All right, then. For more information, visit us
online at www.ncreform101.com.

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