Affordable Care plans are sold by private companies through the Healthcare.Gov marketplace. All Affordable Care plans are major medical plans, which means they all cover what the government defines as essential benefits. An Affordable Care plan is more expensive than a plan that does not cover all essential benefits, but because the marketplace supplements premiums an Affordable Care plan can be very affordable.
Private companies also sell plans independent of the marketplace. These could be full major medical plans such as most group plans. They also sell plans that are not full major medical. These plans, because they do not provide full benefits, have a lower cost..
The table below shows the benefits provided by a full major medical plan compared to a typical private plan. There are times when a private plan makes sense, generally when the client’s income is too high for a supplement or when it is not open enrollment.
| ACA Full Major Medical Covers: |
Private Plans Generally Cover: |
| Preventive, wellness and disease management services |
Preventive, wellness and disease management services |
| Emergency care |
Emergency care |
| Ambulatory services |
Ambulatory services |
| Hospitalization |
Hospitalization |
| Maternity and newborn services |
Not Covered |
| Pediatric services, including dental and vision |
Not Covered |
| Prescription drugs |
Prescription drugs |
| Laboratory services |
Laboratory services |
| Mental health and substance abuse services, including behavioral health treatment |
Not Covered |
| Rehabilitation and habilitation services |
Not Covered |