Guide to healthcare plans outside of the marketplace

Many consumers today are wondering if they can find a healthcare plan that is outside of the marketplace. The only way you can qualify for health plans outside of the marketplace is through a Special Enrollment Period. What does that mean? Well it means that you can find these healthcare plans through insurance companies, insurance agents, brokers, and online health insurance companies that sell these types of plans.

However, please note that at the bare minimum all on-exchange and off-exchange healthcare plans must include 10 essential health benefits, also known as EHB’s.

Here are the 10 essential health benefits categories listed below:

  1. Ambulatory Patient Services
  2. Outpatient Care (not an admittance into a hospital) & Emergency Services
  3. Hospitalization
  4. Maternity and Newborn Care
  5. Mental Health & Substance Use Disorder Services – including behavioral treatment, counseling and psychotherapy
  6. Prescription Drugs
  7. Rehabilitative & Habitability Services and Devices—assists people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills
  8. Laboratory Services
  9. Preventive & Wellness Services & Chronic Disease Management
  10. Pediatric Services, including Dental & Vision Care

Consumers should note that benefits in each category may vary from state to state. This also applies to the health care plans that are available – ever so slightly.Health plans must offer the same basic benefits but are not prohibited from including additional benefits for the consumer.