Essential health benefits, also called essential benefits

Essential benefits are care that health plans, except plans offered by large employers, must cover.

The goal for this set of benefits is to make sure you have access to basic health care. Here are 10 essential health benefits:

  1. Ambulatory care (care you get outside a hospital setting, like doctor’s visits)
  2. Emergency care
  3. Hospital care
  4. Pregnancy, maternity, and newborn care
  5. Mental health and substance use treatment
  6. Certain prescription medicines
  7. Rehabilitative and habilitative services (for example, occupational therapy, physical therapy, and speech-language therapy)
  8. Lab tests
  9. Preventive and wellness care, like cancer screenings and vaccines, and chronic disease management
  10. Care for children (including vision and dental care)

Even though all plans must cover this list of benefits, there can still be some differences between states and health plans.

WebMD Medical Reference Reviewed by Sarah Goodell on June 21, 2021
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