Minimum Essential Coverage Plans- What Do They Really Cover?

Ambulatory Patient Services (Outpatients Services):

These services include healthcare you can get without staying in a hospital. Patients can receive outpatient care in a doctor’s office, a clinic, or an ambulatory surgery center, as well as in an emergency room or an outpatient hospital department. A few of these services include

• Blood tests
• Biopsy
• Chemotherapy
• Colonoscopy
• CT scan
• Mammograms
• Minor surgical procedures
• Radiation treatments
• Ultrasound imaging
• X-Rays

Emergency Services

These services provide emergency care once an incident occurs to ensure the safety and health of the patient. 

Hospital Visits

Under MEC plans, your health insurance will help cover the cost of a hospital visit. This will happen when you’re admitted to the hospital for inpatient care under doctor’s orders. Depending on your MEC plan, you may be covered for different types of care.

Medicare Part A covers semi-private rooms, meals, and general nursing. In addition, it covers drugs as part of your treatment, and other hospital services and supplies.

Maternity and Newborn Care

These services are necessary for the health of a pregnant woman and fetus. They may have become necessary as a result of the pregnancy. These services include prenatal care, labor and delivery, and postpartum care. They also include family planning and services that might be needed with a complicated pregnancy- including diagnoses, illnesses, or medical conditions.

Pediatric Services (Including Oral and Vision)

These are the services that keep your children healthy. For example, dental checkups, eye exams, vaccinations, and well-child visits are included in pediatric services.

Mental Health and Substance Use Disorder Services (Including Behavioral Health Treatment)

These services include counseling, psychotherapy, mental health, inpatient services, and treatment for substance abuse. 

Prescription Drugs

There are various types of prescription drugs that are covered under MEC. For an extensive list check out this site. 

Rehabilitative and Habilitative Services and Devices

Rehabilitative services are services for patients with disabilities, injuries, or chronic conditions. These patients receive coverage for physical, occupational, and speech therapy visits. Habilitative services and devices include those services and devices that help patients learn and improve daily skills.

Laboratory Services

These include preventative screening tests and diagnostic lab tests.

Preventative and Wellness Services and Chronic Disease Management

Preventative care and wellness services are covered in order to ensure early diagnosis. It also helps to ensure the overall health and wellbeing of all patients. These services include cancer screenings, annual checkups, and more at no cost. There are multiple preventative care services that are covered at no cost for all adults, women, and children. 

If you are offering or utilizing minimum essential coverage, you need to understand your coverage. At SBMA, we offer the most comprehensive affordable coverage to help you when you need it most. Learn more about the services SBMA offers here.