Marketplace coverage & essential health benefits

Published on July 28, 2022

There are 10 categories of services — called

— that all private health insurance plans offered in the Health Insurance Marketplace® must cover. What are the 10 essential health 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 Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care (this doesn’t include adult dental or vision coverage) What else does the Marketplace cover? Marketplace plans must also offer birth control and breastfeeding coverage. Some Marketplace plans may have dental and vision coverage too, but these benefits aren’t required. Call your plan to check if it covers a particular service. Get more information on what Marketplace health insurance plans cover.

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