The minimum coverage every marketplace plan is required to include.
Essential health benefits are a set of categories that every ACA marketplace plan is required to cover, regardless of which insurance company sells it. This baseline exists so that no marketplace plan can skip coverage for major categories of care.
These categories include outpatient care, emergency services, hospitalization, maternity and newborn care, mental health and substance use treatment, prescription drugs, rehabilitative services, lab services, preventive care, and pediatric services including dental and vision.
While every marketplace plan must cover these categories, the specific providers, drug formularies, copay amounts, and coverage limits within each category can still vary significantly between plans. Essential health benefits set a floor, not the full picture of what a specific plan covers.
Because the major categories are guaranteed, comparing marketplace plans usually comes down to cost-sharing structure, network, and prescription coverage rather than worrying whether basic categories of care are included at all.
Have more questions? Visit our FAQ page or read the full Coverage Guide.