Marketplace coverage & essential health benefits
Published on July 28, 2022
There are 10 categories of services — called— that all private health insurance plans offered in the Health Insurance Marketplace® must cover.
What are the 10 essential health benefits?
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment, counseling, and psychotherapy
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (this doesn’t include adult dental or vision coverage)
What else does the Marketplace cover?
- Marketplace plans must also offer birth control and breastfeeding coverage.
- Some Marketplace plans may have dental and vision coverage too, but these benefits aren’t required.
- Call your plan to check if it covers a particular service.