What Are Essential Health Benefits?
The ACA requires all marketplace and ACA-compliant private plans to cover 10 categories of essential health benefits (EHBs). These are the minimum services every plan must include — you cannot buy an ACA-compliant plan that excludes any of them.
The 10 Essential Health Benefit Categories
- Ambulatory services (outpatient care — doctor visits, outpatient surgery)
- Emergency services (ER visits — covered at in-network rates even out-of-network)
- Hospitalization (inpatient care, surgery, overnight stays)
- Maternity and newborn care (prenatal, delivery, postnatal)
- Mental health and substance use disorder services (therapy, counseling, rehab)
- Prescription drugs (at least one drug in every category)
- Rehabilitative services and devices (physical therapy, speech therapy, medical equipment)
- Laboratory services (blood tests, diagnostic imaging)
- Preventive and wellness services (checkups, vaccinations, screenings — all at $0)
- Pediatric services (including dental and vision for children)
What Non-ACA Plans May Exclude
Short-term health insurance, fixed indemnity plans, and supplemental plans are not required to cover essential health benefits. Common exclusions on non-ACA plans:
- Maternity care
- Mental health and substance abuse treatment
- Prescription drug coverage (or very limited)
- Preventive care at $0
- Pre-existing conditions
Key distinction: Private ACA-compliant plans purchased directly from carriers (off-marketplace) include all 10 essential health benefits — same as marketplace plans. Only non-ACA plans like short-term insurance can exclude them. This is one of the most important differences when comparing your options.
Related Terms
Last updated: March 30, 2026.
