Which service must be covered by insurance purchased through the marketplace when using an in-network provider?

Which service must be covered by insurance purchased through the marketplace when using an in-network provider?

• A. Cosmetic surgery
• B. Colorectal cancer screening
• C. Fertility treatment
• D. Long-term disability insurance

Answer: (B)

Marketplace health plans are required to cover preventive services with no out-of-pocket costs when you receive them from an in-network provider. Colorectal cancer screening falls into this category of preventive care, so it must be covered without copays, deductibles, or coinsurance when performed by an in-network clinician. This reflects the broad rule that essential benefits and preventive services are provided at no cost to patients within the network. Cosmetic surgery is generally elective and not considered a required in-network benefit, unless it’s medically necessary after an injury or for reconstruction, which is not the typical case. Fertility treatment is not mandated to be covered by marketplace plans, though some plans may include it; it's not guaranteed. Long-term disability insurance is a separate product from health insurance and is not required to be offered or covered by marketplace health plans.

Marketplace health plans are required to cover preventive services with no out-of-pocket costs when you receive them from an in-network provider. Colorectal cancer screening falls into this category of preventive care, so it must be covered without copays, deductibles, or coinsurance when performed by an in-network clinician. This reflects the broad rule that essential benefits and preventive services are provided at no cost to patients within the network.

Cosmetic surgery is generally elective and not considered a required in-network benefit, unless it’s medically necessary after an injury or for reconstruction, which is not the typical case. Fertility treatment is not mandated to be covered by marketplace plans, though some plans may include it; it's not guaranteed. Long-term disability insurance is a separate product from health insurance and is not required to be offered or covered by marketplace health plans.