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See basic health benefits covered by Marketplace plans

published to May 20, 2021

All private health plans offered on the Marketplace must cover these 10 essential health benefits, regardless of plan category and type. (Note: these are, Minimum requirements Applies to all Marketplace plans. The specific services covered by each broad benefit category depend on state requirements. )

Covers Essential Health Benefits

  • outpatient services
  • emergency service
  • hospitalization
  • Pregnancy, Childbirth and Newborn Care (Prenatal and Postnatal)
  • Mental Health and Substance Use Disorder Services
  • Prescription drugs
  • Rehabilitation and Habilitation Services and Devices
  • Inspection service
  • Prevention and health services and chronic disease management
  • Pediatric services, including oral and vision care

Other services may be available

  • Marketplace plans include breastfeeding and birth control coverage.
  • Some plans may also offer dental and vision coverage and medical management programs (for specific needs such as weight management, back pain, and diabetes).

See what else Marketplace Health Plans cover.

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