All plans offered in the Marketplace cover these 10 essential health benefits:

• Ambulatory patient services (outpatient care you get without being admitted to a hospital)
• Emergency services
• Hospitalization (like surgery and overnight stays)
• Pregnancy, maternity, and newborn care (both before and after birth)
• Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
• Prescription drugs
• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

All plans offered in the Marketplace cover these 10 essential health benefits:

• Ambulatory patient services (outpatient care you get without being admitted to a hospital)
• Emergency services
• Hospitalization (like surgery and overnight stays)
• Pregnancy, maternity, and newborn care (both before and after birth)
• Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
• Prescription drugs
• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

Choosing a health insurance plan can be complicated. Knowing just a few things before you compare plans can make it simpler.

• The 4 “metal” categories: There are 4 categories of health insurance plans: Bronze, Silver, Gold, and Platinum. These categories show how you and your plan share costs. Plan categories have nothing to do with the quality of care.
• Your total costs for health care: You pay a monthly bill to your insurance company (a “premium”), even if you don’t use medical services that month. You pay out-of-pocket costs, including a deductible, when you get care. It’s important to consider both costs when shopping for a plan.
• Plan and network types — HMO, PPO, POS, and EPO

Some plan types allow you to use almost any doctor or healthcare facility. Others limit your choices or charge you more if you use providers outside their network.

Source: HealthCare.gov 2023

Understand the basics parts of Medicare Part A, B, C, and D

 Parts of Medicare

Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

Part B (Medical Insurance): Helps cover:

• Services from doctors and other healthcare providers
• Outpatient care
• Home health care
• Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
• Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)

Part D (Drug coverage): Helps cover the cost of prescription drugs (including many recommended shots or vaccines). You join a Medicare drug plan in addition to 

Original Medicare, or you get it by joining a Medicare Advantage Plan

with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow the rules set by Medicare.

Your Medicare options

When you first sign up for Medicare and during certain times of the year, you can choose how to get your Medicare coverage. There are 2 main ways: Original Medicare or Medicare Advantage Part C.

What’s not covered by Part A & Part B

Learn about what items and services aren’t covered by Medicare Part A or Part B. You’ll have to pay for the items and services yourself unless you have other insurance. If you have a Medicare health plan, your plan may cover them.

What’s not covered by Part A & Part B?

Medicare doesn’t cover everything. If you need services Part A or Part B doesn’t cover, you’ll have to pay for them yourself unless:

• You have other coverage (including Medicaid) to cover the costs.
• You’re in a Medicare Advantage Plan

 or 

Medicare Cost Plan

that covers these services. Medicare Advantage Plans and Medicare Cost Plans may cover some extra benefits, like fitness programs and vision, hearing, and dental services.

Some of the items and services Medicare doesn’t cover include:

• Long-Term care (also called custodial care)
• Most dental care
• Eye exams (for prescription glasses)
• Dentures
• Cosmetic surgery  
• Massage therapy
• Routine physical exams
• Hearing aids and exams for fitting them
• Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)
• Covered items or services you get from an opt-out doctor or other providers (except in the case of an emergency or urgent need)

Source: Medicare.gov