All plans offered in the marketplace must meet standards for coverage and consumer protections. These include:
- Essential Health Benefits: All plans must cover 10 essential categories of services, including prescription drug coverage, mental health and substance abuse services, and maternity care.
- Many preventative services are free including well-child visits and vaccinations, smoking cessation services, mammograms and immunizations.
- Out-of-pocket limit: All plans must cap out-of-pocket costs at $6,600 for an individual plan and $13,200 for a family plan for 2016. This limit does not have to include the cost of care received from an out-of-network provider or for services not covered by the plan.
- Standard levels of coverage: All plans must meet standardized levels of coverage. This makes it easier for you to make an apples-to-apples comparison of plans. Generally, Platinum plans will require you to pay less out-of-pocket but will have higher premiums when compared to Bronze or Silver plans.
- Coverage for kids up to age 26: All plans in the marketplace must offer dependent coverage for adult children up to age 26, regardless of whether the child is a tax dependent, where s/he lives, or whether s/he has an offer of coverage at their own job.
- Birth control benefits: Plans in the Health Insurance Marketplace must cover contraceptive methods and counseling for all women. These plans must cover the services without charging a co-pay or co-insurance when they’re provided by an in-network provider. This is true even if you haven’t met your deductible.