Essential Health Benefits (EHBs) refers to 10 categories of services that health insurance plans must cover to be compliant with the Affordable Care Act (ACA).
These services include:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (such as counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (Note: adult Dental and Vision coverage are not essential health benefits.)
In addition, plans must also include birth control coverage and breastfeeding coverage.
Some of the preventive benefits of the ACA are being challenged in court as of 2022. Refer to Explaining Litigation Challenging the ACA’s Preventive Service Requirements, published by the Kaiser Family Foundation in 2023 for additional information.