What Types of Services are Covered by Private Health Insurance Plans?

Private health insurance is a type of coverage that can be offered through an employer or union, or purchased by an individual from a private health insurance company. This type of coverage is often referred to as employment-based health insurance. If you purchase a plan through the Health Insurance Marketplace, your insurance will cover preventive services. If you're self-employed or don't have insurance from your employer, you may be looking for Affordable Care Act insurance, also known as Obamacare.

The five most common types of private health insurance plans are health maintenance organizations (HMOs), participating provider options (PPO), points of service (POS), pay-for-service plans, and health savings accounts. You may be able to pay less for your insurance with a high-deductible health plan (HDHP). No one who applies for health coverage through the individual marketplace will be denied coverage or charged an additional premium due to their health status, medical condition, experience in mental illness claims, medical history, genetic information, or health disability. Health insurance for people age 65 and older, or for people under 65 who may qualify because of a disability or other special situation is also available.

The Affordable Care Act (ACA) requires private plans to cover preventive services recommended by the HRSA's Bright Futures Project without cost sharing. This project provides evidence-based recommendations for improving the health and well-being of infants, children and adolescents. In addition, Congress suspended the typical one-year delay in implementation and required that private insurance plans begin to have full coverage 15 days after the ACIP recommendation for the COVID-19 vaccine. The ACA also requires private health plans to cover recommended preventive services without patients sharing the costs.

Some studies have shown that colorectal cancer screening rates among people with private insurance have increased since the approval of the ACA, while Pap smear rates have declined. Individual and small group plans in the health insurance markets must also cover an essential health benefits (EHB) package that includes the full range of preventive requirements described in this fact sheet.

Tommy Gair
Tommy Gair

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