Health Insurance

What are the essential benefits covered in every plan?

What you need to know

There are ten categories of services that all health insurance plans must cover, as dictated by the Affordable Care Act. These ten categories are, as outlined by Healthcare.gov:

  • Ambulatory patient services (a.k.a. outpatient care that you can receive without being admitted to a hospital)
  • Emergency services
  • Hospitalization for surgery, overnight stays, and other conditions
  • Pregnancy, maternity, and newborn care
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (a.k.a. treatment and devices that help people gain or recover mental and physical skills after an injury, disability, or onset of a chronic condition)
  • Laboratory services
  • Preventive and wellness services, as well as chronic disease management
  • Pediatric services, including dental and vision coverage for children

The specific services offered under these categories may vary from state to state, but these categories represent the minimum that all qualifying health insurance plans are required to cover. All health insurance plans, regardless of whether they are sold on the health insurance exchanges or off-exchange, must cover these ten categories. Plans may choose to cover additional services. State, federal, and private exchanges will show you which exact services each plan covers before you apply.

All health insurance plans must also cover birth control and breastfeeding equipment and counseling. Health insurance plans are not required to cover dental or vision services for adults.

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