Essential Health Benefits
A set of 10 categories of health care services that health plans must cover to meet requirements of the Affordable Care Act.
Essential health benefits include services within the following categories:
- Ambulatory patient services (care you get without being admitted to a hospital)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices (to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive services and chronic disease management
- Pediatric services, including oral and vision care
States expanding their Medicaid programs must provide these benefits to people newly eligible for Medicaid.