Essential Health Benefits
All Marketplace plans must cover a set of 10 categories of services called Essential Health Benefits.
The 10 Essential Health Benefits
Every health plan in the Marketplace must cover these services. This ensures you have comprehensive protection no matter which plan you choose.
Ambulatory patient services (outpatient care)
Emergency services
Hospitalization
Pregnancy, maternity, and newborn care
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
Additional Important Protections
Preventive Services at No Cost
Most health plans must cover a set of preventive services — like shots, screening tests, and annual checkups — at no cost to you. This means no copayment or deductible, even if you haven't met your yearly deductible.
Pre-existing Conditions Covered
Health insurance companies can't refuse to cover you or charge you more just because you have a "pre-existing condition" — that is, a health problem you had before the date that new health coverage starts. This protection applies to everyone, regardless of age or health status.
Need Help Understanding Your Coverage?
Our licensed agents can walk you through each benefit and help you find a plan that covers your specific needs.