Essential Health Benefits
A set of health care service categories that must be covered by certain plans, starting in 2014.
The Affordable Care Act ensures health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, offer a comprehensive package of items and services, known as essential health benefits.
Essential health benefits must include items and services within at least the following 10 categories:
- ambulatory patient services
- emergency services
- maternity and newborn care
- mental health and substance use disorder services, including behavioral health treatment
- 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.
• Plans must offer dental coverage for children but this does not always turn out to be most cost effective way to receive dental coverage for your children. Most plans don't pay until the deductible is met.
Read the plan's details so you don't misunderstand what you are getting.
Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace.
States expanding their Medicaid programs must provide these benefits to people newly eligible for Medicaid.
• MEC vs Essential Health Benefits
• MEC vs Minimum Value
• What types of insurance are not considered MEC?
• 10 categories of health care services that health plans must cover