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What Does Individual Health Insurance Cover?

Individual health insurance plans provide coverage for a variety of medical services and expenses. Understanding what is covered is essential for selecting the right plan to meet your healthcare needs.

1. Essential Health Benefits

Most individual health insurance plans cover ten essential health benefits, including:

  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Prescription medications
  • Preventive services
  • Labs and diagnostic services
  • Mental health and substance use disorders
  • Pediatric services, including dental and vision care

2. Preventive Care

Preventive care, such as vaccinations and annual check-ups, is typically covered at no additional cost. This focuses on early detection and prevention of diseases.

3. Specialist and Primary Care Visits

Individual health insurance often covers visits to primary care providers and specialists, allowing you access to necessary medical advice and treatments.

4. Prescription Drug Coverage

Most plans offer coverage for prescription medications, although specific drugs may have different cost structures.

5. Additional Services

Plans may also cover additional services, such as chiropractic care, acupuncture, and physical therapy, but coverage will vary.

It's important to review the specific terms of your individual health insurance policy to fully understand what is covered and any potential exclusions.

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