In 2014, the Affordable Care Act established 10 essential health benefits, or EHBs, that every traditional health insurance plan must cover. The 10 essential health benefits are services that the ACA requires health plans to cover. What’s covered in the Health Insurance Marketplace. Prior to 2014, the coverage available in the major medical health insurance market ran the gamut from robust to terrible. Under the ACA, the following 10 essential health benefits (www.healthcare.gov) apply to individual/family and small employer health plans: Ambulatory patient services: Covers outpatient care without being admitted to a hospital. Identified as an EHB, mental health and substance use disorder services received federal recognition, igniting a nationwide conversation about mental health. Benefits health plans must cover under the federal ACA. (Learn more about how health insurance works.) But some states require insurers to cover additional services and procedures.

These essential health benefits include at least the following items and services: Outpatient care—the kind you get without being admitted to a hospital; Trips to the emergency room One popular aspect of the Affordable Care Act is its requirement that all individual and small group health plans (for people who don’t have traditional job-based coverage) cover important health benefits like maternity, mental health, preventive, and pediatric dental care. Make sure your plan is compliant. Much of it is preventive care that must be provided at no cost. 02.09.2018. These include well-woman visits, domestic violence screening, and chronic disease management.

Requires that all health care plans include 10 essential benefits: 1. ambulatory patient services 2. emergency services 3. hospitalization 4. maternity and newborn care 5. mental health and substance use including behavioral 6. prescription drugs rehabilitation services and devices 7. laboratory services State requirements that are more comprehensive than the ACA still apply, but in every state, the ACA has established minimum standards. Even within the same state, there can be small differences. These changes are welcome news to people ages 50 to 64 — especially the 9 million uninsured in that group, as well as the 4 million who buy health insurance on their own. Health insurance plans in the Martetplaces can choose which essential health benefits they offer. Prescription drugs are one of the 10 essential health benefits that the ACA statute requires marketplace and individual and small group health policies plans to cover, effective January 1, 2014. . 10 Essential Health Benefits Insurance Plans Must Cover Under the Affordable Care Act. All individual and small-group health insurance plans are required by law to cover the following 10 health benefits. Source: CMS-9980-P: Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation - November 26, 2012 Prescription Drug Coverage as an Essential Health Benefit.