What Are Essential Health Benefits Under the ACA?

The Affordable Care Act (ACA), enacted in 2010, is designed to ensure all legal Americans have access to quality, affordable health insurance. To achieve this goal, the law ensures health plans offered in the individual and small group markets, both within the Health Insurance Exchanges (Exchanges) and outside the Exchange on the open market, offer comprehensive packages of items and services, known as “essential health benefits.”* 

Essential health benefits must include items and services within at least the following 10 categories:

1.   Ambulatory patient services
2.   Emergency services
3.   Hospitalization
4.   Maternity and newborn care
5.   Mental health and substance use disorder services, including behavioral health treatment
6.   Prescription drugs
7.   Rehabilitative and habilitative services and devices
8.   Laboratory services
9.   Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

These standardized health insurance plans (in the form of four metallic plans) will become available when the Exchange becomes operational in your state beginning October 1, 2013 for plan year 2014.  Stay tuned to our blog and check your state’s Health Insurance Exchange webpage as well for more specific information that could affect you personally.

*The majority of this blog was reprinted from the US Department of Health and Human Services Bulletin, February 2012

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