Essential Health Benefits under the ACA

Getting health coverage is just the first step to healthy and happy. Knowing how to use your health coverage effectively is what comes next.

Every health insurance plan purchased on the health marketplace comes with “Essential Health Benefits (EHBs).”

Under the Affordable Care Act (ACA), every health plan sold on the health marketplace and in small group markets must carry a set of 10 categories of services, including doctors’ services, inpatient and outpatient hospital care. These also include: prescription services, pregnancy and childbirth, and mental health. Some plans cover even more than is minimally required. Children covered under the ACA also receive dental benefits.

These are a given, no matter how much your deductible is, co-pays or co-insurance.  Make sure you know your EHB’s:  

·         Emergency services

·         Ambulatory patient services (outpatient care you get without being admitted to a hospital)

·         Hospitalization (like surgery and overnight stays)

·         Pregnancy, maternity and newborn care (both before and after birth)

·         Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)

·         Prescription drugs

·         Rehabilitative and rehabilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)

·         Laboratory services

·         Preventive and wellness services and chronic disease management

·         Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

Including these benefits in every policy has made health insurance coverage more comprehensive for consumers. This also protects them from unforeseen medical bills for essential services, including maternity and prescription drugs. Those consumers with pre-existing conditions benefit, too because insurers can’t “opt out” of certain expensive services, like diabetes or asthma coverage.

Learn more:

Have more questions on how to use your health coverage? Contact the Epilepsy Foundation of Florida navigation services at 877-553-7453. We’re here to help!

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