Here are the ten "essential" benefits all the individual and small groups plans must include:
Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services chronic disease management
Pediatric services
Even “gold” is at 4k per year out of pocket maximum. Most current Cadillac offerings are at around $500 to $1000 out of pocket maximum.
I wonder if standard operational definitions for the ten essential benefits are stated somewhere or if the categories are just names.
For example, a plan could include “prescription drugs” but the actual included list is so restrictive as to be useless, or no better than what Walmart offers at $4 anyway.
It’s really going to be treacherous for the consumer to make their decisions. I’m not looking forward to it. Fortunately, I do have basically full time to research.