Ten essential benefits in insurance plans on the marketplace

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KANSAS CITY, Mo. -- The health insurance plans on the marketplace starting Tuesday are required to cover 10 things. In our coverage of the health care puzzle, here are those so-called "essential health benefits":

1. Outpatient care
2. E.R. visits
3. Treatment in the hospital
4. Care before and after your baby is born
5. Mental health and substance use disorder services
6. Prescription drugs
7. Services and devices to help you recover if you're injured, have a disability or chronic condition
8. Lab tests
9. Preventive services including counseling, screenings and vaccines
10. Pediatric services including dental and vision care for your kids.

"Some (benefits) that have been in a lot of plans before, but we're making sure everyone knows that these 10 essential benefits will be in every plan that's on the marketplace," said Stephene Moore, Regional Director of the U.S. Department of Health and Human Services.

The marketplace is at healthcare.gov. The 10 essential benefits will also be in individual and small group plans that aren't sold on the marketplace.

Some question whether the benefits are essential. After all, does a 50-year-old man need maternity coverage?

"Whether you want it or not, your premium is going to be a lot more whether you want maternity or not," said Beverly Gossage of HSA Benefits Consulting.

The independent insurance agent said insurers are increasing prices by 25 to 50 percent for her clients who already have individual or small group coverage.

But Moore countered that premiums on the marketplace are coming in 16 percent lower than anticipated. She said when you consider the 50-year-old man who's paying for maternity coverage, you should also think about the 28-year-old woman who doesn't need a prostate exam.

"It will all even out to where it's spread greatly across everyone who's purchasing insurance through the marketplace," said Moore.

Gossage also pointed out that the dental and eye coverage for your kids can apply to your deductible, so you'll pay out of pocket for those services until you reach your deductible which can be hundreds of dollars.

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