Every private health insurance plan offered by the Marketplace will offer the same set of essential health benefits. The essential benefits of the Marketplace will include hospitalization (such as surgery), ambulatory patient services (outpatient care you get without being admitted to the hospital), and emergency services.
These plans will also cover pediatric and laboratory services, prescription drugs, mental health and substance use disorder services, preventive/wellness services, chronic disease management, pregnancy, maternity, and newborn care (care before and after your baby is born. Rehabilitative and habilitative services and devices such as devices and services to help those recover or gain mental and physical skills, chronic conditions, disabilities, and injuries.
Essential health benefits are minimum requirements for every plan in the Marketplace. These plans could offer additional coverage. You will see exactly what these plans offer when you compare them side-by-side in the Marketplace. The additional benefits could include dental coverage, birth control benefits, and breastfeeding benefits.
Essential health benefits for pre-existing medical conditions will be covered under every Marketplace plan. This means no insurer can refuse to pay for essential health benefits, reject you, or charge you more for any medical condition you had before your coverage began. This cover will also include pregnancy. If you become pregnant and then enroll into a Marketplace plan during Open Enrollment or with a Special Enrollment Period, care for your pregnancy including childbirth will be covered when your new plan starts.
Most people who live in the United States must carry health insurance or they will have to pay a fee. If a person can afford health insurance and chooses not to buy coverage, must pay a fee. The fee is sometimes called a fine, penalty, individual mandate, or individual responsibility payment.
If you do not have coverage in 2017, you will pay the higher of the following two amounts: 2% of your yearly household income. Only the amount of income above the tax filing threshold, about $10,000 for a single person, is used to calculate the penalty. The maximum penalty is the national average premium for a bronze plan. ) Or $325.00 per person for the year. ($162.50 per child who is under 18). The maximum penalty per family using this method is $975.00. The penalty will increase each year. In 2016 it will increase to $695 per person or 2.5% of income. After that it will be adjusted for inflation.
You will pay the fees on the federal income tax return you file for the your in which you did not have coverage. Most people will file their 2015 returns in early 2016 and their 2016 returns in early 2017.