Individual health insurance plans are subject to the Affordable Care Act (ACA) provisions as well as whichever state laws apply. Because of the Affordable Care Act, most people are required to have health insurance or pay a fee.1 It’s important to know that not all individual health plans meet the requirements of insurance as defined by the ACA. It may be possible to buy health insurance in Wisconsin and still be required to pay the fee if the health plan doesn’t meet the ACA requirements.
Individual insurance plans that meet the ACA rules must cover essential health benefits.2 These benefits include –
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (such as surgery)
- Pregnancy, maternity, and newborn care (care before and after your baby is born)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services
Covered preventive services include screenings, vaccinations, tobacco cessation and more – all at no out-of-pocket cost to you when you visit an in-network provider.
Unity offers a variety of individual health insurance plans in Wisconsin that meet these ACA and state requirements.