All Marketplace health insurance plans must cover 10 categories of essential health benefits. Essential health benefits are minimum requirements for all Marketplace plans. Specific services covered in each category may be different based on your state's requirements.
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10 covered 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
Services like physical therapy, occupational therapy, and speech therapy
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care (doesn’t include adult dental or vision coverage)
Plans must also include birth control and breastfeeding coverage. Some plans may offer dental and vision coverage.
