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How can a consumer find out the details about what a particular plan covers?


All individual and small employer plans that are not grandfathered plans offered after January 1, 2014 will cover essential health benefits.

To learn if a specific benefit is covered, and at what level, check a plan's Summary of Benefits and Coverage (SBC). An SBC is a uniform document that includes details about what a plan does and doesn't cover. It also includes information about what kinds of costs a consumer can expect to pay out-of-pocket, such as deductibles, coinsurance, and copayments. An SBC comes with plans offered through the exchange and in the market outside the exchange. It gives information in the same way for every plan to make it easier to compare plans. The SBC forms will be available through the Health Insurance Marketplace or from an agent for plans offered in the market outside the exchange.

The Health Insurance Marketplace website at healthcare.gov includes information about what each plan covers and links to the insurer's plan brochures.

Consumers can read more about the Summary of Benefits and Coverage.

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