What Are Essential Health Benefits?
Essential Health Benefits (EHBs) are the 10 categories of healthcare services that all ACA-compliant plans must cover. Insurers cannot put annual or lifetime dollar limits on EHB coverage.
The 10 Essential Health Benefit Categories
- Ambulatory patient services — outpatient care and doctor visits
- Emergency services — ER visits
- Hospitalization — inpatient care and surgery
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services — physical therapy, speech therapy
- Laboratory services
- Preventive and wellness services
- Pediatric services — including dental and vision for children
💡 Before the ACA, many plans excluded maternity care, mental health coverage, or prescription drugs entirely. EHBs ensure all ACA plans provide comprehensive coverage.
What's Not Included in EHBs
- Adult dental and vision (not required but often offered as add-ons)
- Long-term care
- Cosmetic procedures
- Weight loss programs (unless medically necessary)
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