Health Insurance Benefits

Under the Affordable Care Act

Essential Benefits and Preventative Care

The Affordable Care Act ensures all health plans offered in the individual and small group markets, both on and off the Health Insurance Marketplace, cover a comprehensive package of items and services, known as Essential Health Benefits.

The ACA additionally mandates that preventative health coverage is covered at no cost to you. Preventative care covers a broad range of services, from your annual wellness check and blood work to health screenings and vaccinations.


Essential health benefits must include items and services within at least the following 10 categories:

  • Outpatient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care. Adult dental and vision coverage are not considered Essential Health Benefits.

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