Affordable Care ACT Services

Choosing an Affordable Care ACT health insurance plan is an important decision, but enrollment options can be confusing. FACT has certified counselors trained to provide health insurance information and assistance to chose among plans available to people applying for coverage.


What Does Health Insurance Cover?

Starting in 2014 new health insurance plans must cover core benefits, called essential health benefits, including:

  • Ambulatory service, like visits to your doctor's office.
  • Emergency Services.Hospitalizations, usually round-the-clock care for people in the hospital.
  • Maternity and newborn care for pregnant women, new moms, and their babies. These services include breastfeeding pumps, well-baby visits, and gestational diabetes screening to help keep moms and babies healthy.
  • Mental health and substance abuse services, including counseling to treat depression and alcohol abuse.
  • Prescription drugs
  • Rehabilitation and habilitative services. Rehabilitative services may include physical therapy, occupational therapy, or walkers to aid in recovery following an illness or injury. Habilitative services include things like hearing aids that allow people to keep or get skills important for daily living. 
  • Laboratory services like blood test your doctor may use to treat you.Prevention services and chronic disease management to help prevent and control conditions.

Some plans may also include more benefits than what they are required by law. Insurance companies cannot put life limits on essential health benefits, but they can still place limits on nonessential benefits. For example, your health plan can limit how much it will cover for dental care each year or over your lifetime, because dental care for adults is not an essential benefit.

For more information or assistance with the Affordable Care ACT please contact us


How Does Insurance Work?

Some plans may also include more benefits than what they are required by law. Insurance companies cannot put life limits on essential health benefits, but they can still place limits on nonessential benefits. For example, your health plan can limit how much it will cover for dental care each year or over your lifetime, because dental care for adults is not an essential benefit.

  • Premiums - A premium is a set amount you pay for your health insurance plan, usually paid every month. You pay your premiums even if you don't receive medical care for that month. 
  • Deductibles - A deductible is the amount of money you pay for health care service before your insurance plan will begin to pay for the covered health services. For example, if your health insurance plan has a $1,000 deductible you must pay $1,000 for medical care before your insurance starts paying. A deductible may not apply to all health services, such as preventive care. 



For more information or assistance with the Affordable Care ACT please contact us