Marketplace Health Insurance Coverage

female_half_hiddenStarting in 2014 a new set of health care service categories in place. These categories MUST be covered by insurers. It is based on the concept of Essential Health Benefits and the Affordable Care Act.

This act will ensure that the health insurance plans offered by companies to individuals and small groups (such as small businesses) will include a comprehensive package of services and other items. Different plans MAY offer additional services. This is where you compare and find the plan that is right for you and your family.

Please note, that insurance companies will still offer plans outside the HealthCaregov website. They are simply an aggregator of plans that insurance companies have opted to join.

A New Way to Lower Health Insurance Premium Costs

  • A new refundable or Advanced Premium Tax Credit (APTC) that lowers the cost of Qualified Health Plans
  • Eligibility is based on Household income, and family size (at end of year)
  • Income between 100% to 400% of the Federal Poverty Level (FPL) ($23,550 – $94,200 for a family of four in 2013)
  • Obtaining qualified health insurance through the Marketplace
  • Ineligibility for government-sponsored coverage, affordable employer-sponsored insurance, or certain other minimum essential coverage

The Premium Tax Credit is claimed on your income tax return

The bare minimum of services required under the essential health benefits are:

  • Marketplace Health Insurance Coverage | Coverage | Healthcare.gobPatient Services – Ambulatory
  • Emergency Treatments
  • Hospitalization
  • Maternity Care
  • Newborn Care
  • Mental Health
  • Substance Abuse Disorders
  • Behavioral Treatment
  • Prescription Drugs
  • Rehabilitative Services
  • Lab Work
  • Preventive/Wellness Services
  • Chronic Diseases
  • Pediatric Services

ALL insurance policies are required to cover these benefits to be certified. Once certified, their policies will be able to be offered in the Health Insurance Marketplace. Note that all Medicaid state plans must cover these services by 2014.


Marketplace Health Insurance Coverage | Coverage | Healthcare.gob