10 Essential Health Benefits of the Affordable Care Act

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By Amy Blitchok Google

Prior to the passage of the Affordable Care Act (ACA), insurance companies had the freedom to drop people from their plans, reject those with pre-existing conditions, and limit access to what some consider essential health benefits.  Insurance company policies sometimes made it seem like cutting costs was the number one priority, even at the expense of consumers.  Under the ACA, health plans are required to offer services that cover a total of 10 different categories that have been deemed as essential:

 

Ambulatory Patient Services
This covers a variety of services from visits to a clinic, medical office, or same-day surgery facility.  This category covers a wide range of treatments and come of the most common type of visits.
 
Emergency Services   
In 2011, 20% of all Americans made at least one trip to the emergency room.   Under the ACA, patients can visit any hospital without preauthorization or having to pay out of network fees.  The average cost of a visit to the ER is about $2,000.   
 
Hospitalization
Any care you receive as a hospitalized patient must be covered.  This includes surgery and transplant related services.  
 
Maternity and newborn care
This category includes prenatal care, through the labor, post-delivery and newborn stages.  
 
Mental Health and Substance abuse services
Patients can now have affordable access to a variety of therapeutic services.  While there are certain restrictions that vary from state to state, this provision does  make it easier to receive services.  
 
RXPrescription drugs
Before the ACA became law, insurance companies could offer prescription drug coverage for an extra cost.  Now, they are required to provide at coverage for at least on drug in every major pharmaceutical category.
 
Rehabilitative and habilitative services and devices
Physical therapy, as well as, rehabilitative equipment must be provided under this provision.  This will allow people who are recovering from injuries or trying to manage progressive diseases like multiple sclerosis to recover and maintain mobility.
 
Laboratory services
Typically, these services involve screening tests such as Pap smears and prostate exams.  Some programs may also cover expensive diagnostic tests.
 
Preventative and wellness services
The goal of this essential benefit is to have patients and doctors work together more closely to develop strategies and make lifestyle choices that will help prevent chronic diseases.   This may be as simple as seeing your doctor for an annual check-up. 
 
Pediatric services 
Children under the age of 18 are eligible for both dental and vision services.  Parents won’t have to worry about paying out of pocket for teeth cleanings and eye exams.
 
If you are receiving Medicare benefits, understanding what is and is not covered can be a little more confusing.  Not sure whether Medicare will reimburse the cost of you your mobility and accessibility equipment?  Visit the Medicare website or call AmeriGlide at (800) 790-1635 to speak with an expert who can answer your questions and help you receive affordable equipment if you don’t qualify for assistance.
 

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