In the past, each hospital has been able to select which insurance plans it will accept. This could mean that if you got sick or injured while traveling, for example, and you had to visit an emergency room that you may have had to pay entirely out of pocket for care provided at that distant hospital if they “didn’t take your insurance.”
This will no longer happen to a large degree. All Marketplace plans will offer the same set of essential health benefits, Emergency services, laboratory services and hospitalization are a few of the essential benefits guaranteed to be included in every Marketplace plan and to be accepted by every hospital. Insurance plans will not be able to require higher co-payments or coinsurance if you get emergency care from an out-of-network hospital. They also cannot require you to get prior approval before seeking emergency room services, even if that provider or hospital is outside your plan’s network. This means that when you are traveling away from your hospital network and need to visit an emergency room, your health insurance plan will provide coverage in the same way and with the same co-payments, co-insurance, etc. as if you had walked into the emergency room down the street.
An exception to this is possible in health plans created or bought before March 23, 2010, which are known as grandfathered plans. If you purchase insurance through your workplace and are not sure whether your plan is “grandfathered,” contact your employer or your benefits administrator to predict any out of the ordinary cost you should expect in the scenario described above. Many employer plans do provide the essential benefits even though they may not technically be required to under the new law, so there may be no difference in the costs you would experience away from home.
To learn more, click on this article on How the Healthcare Law Protects You.
This work is supported in part by New Technologies for Agriculture Extension grant no. 2020-41595-30123 from the USDA National Institute of Food and Agriculture. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the U.S. Department of Agriculture.
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