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Health Care Reform:

Health Insurance & Affordable Care Act

Insurance Marketplaces: What Your State Decides

The Decisions Your State Can Make continued...

Treatments that are covered. Although the law set the 10 general categories that essential health benefits must cover, it did not list all the services that fall under each category.

Each state is allowed to identify an existing plan as a benchmark for the essential health benefits. As a result, health plan benefits vary from one state to another.

For example, some plans may pay for weight loss surgery, but others may not. Some plans may cover infertility treatments, but others may not. 

One plan may only cover a few drugs for your condition -- like medicine for high blood pressure -- while another plan may cover many brands.

States can also decide what complementary and alternative treatments count as essential benefits. For instance, some states -- like California, Maryland, New Mexico, and Washington -- are including acupuncture as an essential health benefit. Many other states probably won't.

Special programs. State Marketplaces may offer extra coverage for health problems that are more common in that state. For instance, if a state has high levels of diabetes, its Marketplace might include more plans that have special programs to help people with that condition.

Coverage for more people with low incomes.  One way health reform was supposed to help more people get medical care was to expand each state's Medicaid plan. Medicaid is the free or low-cost health program for people with very low incomes.

However, states can decide whether or not to expand Medicaid. If a state doesn’t expand Medicaid, some low-income people won't be able to afford coverage. To find out whether you qualify for Medicaid, check out the insurance finder on HealthCare.gov.

3 Things to Know About Your State's Marketplace

Plans will vary state-to-state. If you're trying to help an out-of-state relative buy a plan, remember that their options will be different from yours.

Learn about your state's plan. You can find details about what’s offered in your state by going to our interactive map.

You may get a price break. Your state's Marketplace will let you know whether you can get financial help, called a subsidy or tax credit, from the government. This can lower your monthly payment for health insurance and, in some cases, lower your out-of-pocket costs. Your state Marketplace will also show whether you qualify for Medicaid.

WebMD Medical Reference

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