What are essential health benefits under the Affordable Care Act (ACA)?

Author: Jayne Zanglein, Western Carolina University

Under the ACA, employers that provide health coverage to employees are required to have a health plan that provides essential health benefits. The scope of essential health benefits will be further defined by the Department of Health and Human Services (HHS), and will include items and services in at least the following categories:

  • Ambulatory patient services, such as doctor's visits and outpatient services;
  • Emergency services;
  • Hospitalization;
  • 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;
  • Chronic disease management; and
  • Pediatric services, including oral and vision care.