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
  • Hospitalization
  • 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.

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