Marketplace coverage & essential health benefits

Published on July 28, 2022

There are 10 categories of services  called

essential health benefits
 that all private health insurance plans offered in the Health Insurance Marketplace® must cover.

Cartoon woman holds magnifying class that shows the number "10."

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?

Get more information on what Marketplace health insurance plans cover.