Health Coverage for Individuals and Families

Essential Health Benefits

Marketplace coverage comes with 10 essential health benefits with no lifetime or annual dollar coverage limits.

Plans must provide coverage for these products and services:

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

Prevention

Another key part of the Affordable Care Act is its focus on preventive care. Preventive services are available for adults and children, and they include these and other services:

• Blood pressure screenings
• Cholesterol screenings
• Colorectal cancer screenings
• Depression screenings
• Diabetes (type 2) screenings
• HIV screenings
• Immunizations
• Breast cancer screenings (mammograms)
• Breast cancer chemoprevention counseling for women at higher risk
• Cervical cancer screening
• Autism screening for children at 18 months and 24 months
• Developmental screening for children younger than 3
• Vision screening for all children

Not all preventive services are recommended for every patient every year, so talk to your doctor about which preventive services are right for you.

Access to coverage

Before you select your plan, it is important to determine if you are eligible for financial assistance. Depending on your income and family size, you may qualify for federal help.

Through Pennie, Pennsylvania’s new health insurance marketplace, you may be eligible for the following:

Premium tax credits: These can help you pay your monthly bill.

Cost-sharing reductions: These can lower your out-of-pocket expenses when you go to a doctor or hospital.*

Many people are eligible for financial assistance. Find out if you might qualify.

*Native American/Alaska Native members who are eligible for cost-sharing reductions will not be charged for items or services provided by the Indian Health Service or a tribe, tribal organization, or urban Indian organization.