Does Obamacare Cover Surgeries?

Does Obamacare Cover Surgeries?

Does Obamacare Cover Surgeries? What Does Health Insurance Cover

The aim of the Affordable Care Act (ACA) is to ensure that all Americans obtain reasonably priced health insurance. Is surgery covered by Obamacare plans? is an essential concern that many people have when handling the complicated of health insurance. The short answer is that Obamacare does cover surgeries, but there are restrictions and different levels of coverage.

If you have health insurance, you should find out how much of the procedure your plan would likely pay for. This post will outline the information you should know about your health insurance plan and the inquiries you should make to make sure the bills you receive don’t come as a surprise.

Obamacare Covered Benefits:

Essential health benefits are required to be covered by all health insurance plans available on the Health Insurance Marketplace under the Affordable Care Act (ACA). These advantages, which were created to provide thorough coverage, consist of:

  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care (this doesn’t include adult dental or vision coverage)
  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (like surgery and overnight stays)
  • Pregnancy and newborn care (both before and after birth)
  • Mental health and substance use disorder services, including behavioral health treatment, counseling, and psychotherapy
  • Prescription drugs

What Does Health Insurance Cover

Out-of-pocket maximums and cost-sharing

Cost-sharing provisions found in Obamacare plans, like as deductibles, copayments, and coinsurance, control the amount of money policyholders must pay for procedures out of pocket. Furthermore, after the out-of-pocket maximum is met, the insurance provider will cover all eligible services at 100% for the remainder of the year.

Does Obamacare pay for health care costs?

Your medical costs are partially covered by the plan. After you’ve paid your deductible, marketplace plans will reimburse between 60% and 90% of your eligible costs. Once your deductible has been paid, the portion of a covered health care service’s expenses that you still have to pay (20%, for example).

Does Obamacare pay for injuries that occurred before?

Health insurance companies are prohibited under the Affordable Care Act from refusing to cover you or raising your premiums just because you have a “pre-existing condition,” or a medical issue that existed before the start date of your new policy. Women cannot be charged more than men, either.

Coverage for pre-existing conditions

All Marketplace plans must cover treatment for pre-existing medical problems.

  • No insurance plan can reject you, charge you extra, or refuse to pay for essential health benefits for any condition you had before your coverage started.
  • The plan cannot refuse to cover you after you enroll or increase your premiums solely based on your health.
  • Because of your pre-existing condition, Medicaid and the Children’s Health Insurance Program (CHIP) are likewise not allowed to deny you coverage or charge you extra.

Exception: grandfathered plans don’t have to cover pre-existing conditions

Preventive care and pre-existing conditions are not required to be covered by grandfathered plans. There are two ways to get pre-existing conditions covered under a grandfathered plan:

  • During Open Enrollment, you can move to a Marketplace plan that will include them.
  • When the year for your grandfathered plan expires, you can purchase a Marketplace plan outside of Open Enrollment and be eligible for a Special Enrollment Period.

Learn more about grandfathered plans and what to do when your plan is changed or cancelled.


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