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
- 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).