What Are Essential Health Benefits?

By | March 2, 2015

There are certain Essential Health Benefits must be offered at no dollar limits on every plan under the Affordable Care Act (ObamaCare). These are the plans that are available for purchase from the Health Care Marketplace online. Many Americans that do not receive insurance through an employer provided plan will need to buy health insurance on the marketplace.


Affordable Care Act (ACA or ObamaCare)

The Affordable Care Act (ACA or ObamaCare) ensures that health plans Individual and group markets both inside and outside the Health Insurance Market, offering a comprehensive package of products and services, which are known as health services essential. 


ACA and Taxes

The essential health benefits must include at least the following 10 categories: outpatient services; emergency services; inpatient services; maternity and neonatal care; mental health and disorders associated with the consumption of narcotics, including behavioral health treatment; prescription drugs; rehabilitation services and devices; laboratory services; preventive and wellness services and chronic care; and pediatric services, including oral and vision care.


Other benefits under Affordable Care Act

The essential health benefits are minimum requirements for all plans Marketplace insurance plans. You may provide additional coverage plans. You will see exactly what each plan when compare point by point in the market.

Additional benefits are:

  • Benefits of Birth Control
  • Benefits of breastfeeding
  • Dental Coverage


Are the same health benefits in each state?

Generally, yes. But while Marketplace plans generally offer the same set of essential health benefits, specific benefits may vary by state. Some states require insurers to cover certain services and procedures. Even within the same state there may be some minor differences between the plans.

When filling out the application in the market and compare insurance plans will see what are the specific benefits of each plan. Please read the details of the plan before enrolling.


What if the specific treatment I need is not on this list?

The insurance plans cover many individual services within the broad categories of this list. When you compare plans in the marketplace, you can view detailed information about benefits covered under these categories. In addition, states may require plans that cover other benefits. Plans may also choose to cover additional benefits.

The health benefits are covered regardless of the category of plan you choose Marketplace. This also applies to the catastrophic plans . Learn more about the different categories of plans. All the plans available in the marketplace have to cover essential health benefits. Learn more about the different types of health plans.


How do insurance plans differ?

All plans have deductibles , copayments , and other direct costs out of pocket that apply to most of the benefits. These costs differ somewhat depending on which category of plan] (/ glossary / health-plan-categories “glossary” “) you choose.