All private health insurance plans offered in the Health Insurance Marketplace® must cover the same essential health benefits. Care in these 10 categories of services is covered by all Marketplace plans.
10 covered benefits:
Ambulatory patient services (outpatient care you get without being admitted to a hospital)
Emergency services
Hospitalization (like surgery and overnight stays)
Pregnancy and newborn care (both before and after birth)
Mental health and substance use disorder services, including behavioral health treatment, counseling, and psychotherapy
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 (this doesn’t include adult dental or vision coverage)
In addition, plans must also include birth control and breastfeeding coverage. Some plans may offer dental and vision coverage.
Specific services may vary based on your state’s requirements. Get more information on what Marketplace health insurance plans cover.
