Top 10 Overlooked Benefits in ACA Plans

1. Dental and Vision Coverage for Children

While adult dental and vision coverage isn’t required under the ACA, pediatric dental and vision are considered essential health benefits. This means:

• All ACA-compliant plans must offer these for children under 19.
  
• Includes dental checkups, cleanings, fillings, and vision exams, glasses, or contacts.
  

2. No Annual or Lifetime Limits

ACA plans eliminated annual and lifetime coverage caps for essential health benefits. That means:

• You won’t lose coverage or be cut off if you have a major health crisis or chronic illness.
  
• Particularly important for patients managing conditions like cancer, hemophilia, or multiple sclerosis.
  

3. Free Preventive Services for Adults

Beyond flu shots and mammograms, plans must offer a wide range of preventive services at no cost, such as:

• Depression screening
  
• Obesity and alcohol misuse counseling
  
• Type 2 diabetes screening
  
• HIV and STI testing
  
• Contraceptive counseling and supplies (for women)
  

These services can help prevent bigger, costlier health issues down the road.

4. Rehabilitative and Habilitative Services

ACA plans cover both:

• Rehabilitative services: help you recover skills lost from an injury, accident, or illness (e.g., physical therapy, speech therapy).
  
• Habilitative services: help you gain skills you never had due to a disability (e.g., occupational therapy for a child with autism).
  

These benefits are especially valuable for people with chronic conditions, injuries, or developmental delays.

5. Mental Health and Substance Use Disorder Services

Many consumers are unaware of how comprehensive this coverage is:

• Includes therapy, inpatient mental health care, medication management, and addiction treatment.
  
• Requires parity with medical and surgical benefits—meaning mental health services can’t have higher copays or stricter limits.
  

6. Pregnancy, Maternity, and Newborn Care

Maternity coverage is mandatory in all ACA-compliant plans, even if you’re not pregnant when you sign up. Covered services typically include:

• Prenatal visits and testing
  
• Labor and delivery
  
• Postnatal checkups
  
• Newborn pediatric care
  

7. Free Breastfeeding Support

Plans must cover:

• Lactation counseling
  
• Breastfeeding support services
• Breast pumps (rentals or purchases, depending on the plan)
  

Many new parents overlook this benefit and pay out of pocket when it’s covered.

8. Coverage While Traveling or Relocating

Many plans have national provider networks or telehealth services that allow:

• Access to care while traveling out of state.
  
• Continued coverage when you temporarily relocate (like students or seasonal workers).
  

It’s often misunderstood how mobile ACA plan coverage can be.

9. Marketplace Support Tools

Although not part of the insurance plan itself, ACA marketplaces offer:

• In-person and virtual enrollment help
  
• Eligibility screeners for subsidies
  
• Access to multilingual navigators and call center staff who can assist with claims issues, coverage questions, and appeals.
  

10. Essential Drugs and Formulary Coverage

ACA-compliant plans are required to cover at least one drug in every U.S. Pharmacopeia category and class, which:

• Ensures coverage of a broad spectrum of medications, including those for chronic conditions like asthma, depression, and diabetes.
  
• Includes both generic and name-brand options.
  

What ACA Plan Benefits Matter Most for You?

ACA health plans are more versatile than most people realize. Depending on your life stage, family needs, or health situation, here are the most overlooked but valuable benefits to look for when reviewing or enrolling in coverage:

Young Families or Expecting Parents

• Look for:
  • Free prenatal, maternity, and newborn care
    
  • Breastfeeding support and free breast pumps
    
  • Pediatric dental and vision coverage

• Why it matters: Comprehensive support through pregnancy, delivery, and early childhood reduces out-of-pocket costs and ensures early intervention when needed.

Young Adults or Students

• Look for:
  • Free preventive services (STI testing, mental health screenings)
    
  • Telehealth options for when you’re away at school
    
  • Rehabilitative therapy (post-injury or post-surgery)

• Why it matters: Affordable access to health and wellness services, even across state lines or while living away from home.
  

Individuals Managing Mental Health or Addiction

• Look for:
• • Mental health parity (equal coverage as medical care)
    
  • Access to inpatient and outpatient services
    
  • Substance use treatment and medication-assisted therapy
• Why it matters: Consistent care and medication coverage can be life-changing for those managing chronic conditions or recovery.
  

Older Adults or Those with Chronic Illness

• Look for:
  • No lifetime/annual caps on essential care
    
  • Rehabilitative services like physical therapy
    
  • Broad prescription drug coverage
• Why it matters: Ensures continuous care and protection from large medical bills due to long-term illness or injury.
  

People with Disabilities or Special Needs

• Look for:
  • Habilitative services for skill-building (e.g., speech therapy, OT)
    
  • Extended therapy and equipment coverage
    
  • Plans that cover in-home care or specialized providers
• Why it matters: Access to long-term, skill-based therapy can dramatically improve quality of life and independence.
  

Frequent Travelers or Remote Workers

• Look for:
  • National provider networks
    
  • Flexible telemedicine
    
  • Emergency coverage outside your home state
• Why it matters: Your care should travel with you, especially if you’re a digital nomad, seasonal worker, or caregiver splitting time in multiple locations.
  

Final Tip

During open enrollment, or when qualifying for a special enrollment period, take time to review your options. Speak with a licensed insurance agent or easily compare plan options online through our search portal.