All private health plans offered in the Marketplace must cover these 10 essential health benefits regardless of the plan category and type. (Note: These are the minimum requirements for all Marketplace plans. Specific services covered in each broad benefit category can vary based on your state’s requirements.)
Covered essential health benefits
- Ambulatory patient services
- Emergency services
- Hospitalization
- Pregnancy, maternity, and newborn care (pre and post birth)
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Other services may be available to you
- Marketplace plans include breastfeeding and birth control coverage.
- Your plan may also offer dental and vision coverage and medical management programs (for specific needs like weight management, back pain, and diabetes).
