What are essential health benefits (EHBs)?

Essential health benefits (EHBs) are a set of health care service categories that the Affordable Care Act (ACA) mandates must be covered by certain health plans, particularly those sold through the Health Insurance Marketplace. The purpose of EHBs is to ensure that individuals have access to a comprehensive range of necessary services without facing overwhelming costs.

The ACA specifies ten categories of essential health benefits that must be covered, including services like outpatient care, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitation services and devices, laboratory services, preventive services, and pediatric services. This comprehensive coverage helps to guarantee that consumers have access to a wide array of health care necessary for their well-being.

This requirement plays a vital role in public health by ensuring that individuals cannot be denied coverage for these basic services, which in turn promotes broader societal health outcomes. This contrasts with optional services or supplementary benefits, which are not mandated by law and can vary significantly between insurance plans. Additionally, services not typically covered under standard medical plans do not align with the objective of EHBs to standardize and increase the accessibility of critical health services.