Essential Benefits Under the Affordable Care Act

What do Affordable Care Act plans have to cover?

All ACA health insurance plans must include certain "essential benefits."


Updated: 2022-10-13

All health plans purchased through a state health insurance marketplace must include the following benefits. These are known under the Affordable Care Act as “essential health benefits”:

  • Ambulatory patient services (meaning outpatient care you receive without being admitted to a hospital)
  • Emergency services
  • Hospitalization (including surgery)
  • Maternity and newborn care
  • Mental health and substance use disorder services (including counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (for people with injuries, disabilities, or chronic conditions, to strengthen their mental and physical skills)
  • Lab services
  • Preventive and wellness services and chronic disease management
  • Pediatric services (including oral and vision care)

To learn more and find plans available where you live, choose your state or enter your zip code.

Jurisdictional relevance: US

Legal Consumer - Law. The content of this article pertains to all US states and counties.


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