Health Team

Tutorial: 10 essential benefits of Affordable Care Act coverage

Under the Affordable Care Act, health insurance plans offered to individuals must cover 10 essential benefits.

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RALEIGH, N.C. — Under the Affordable Care Act, health insurance plans offered to individuals must cover 10 essential benefits.

That means the plans will cost more, but coverage is also more comprehensive.

The 10 essential health benefits are as follows:

  • Ambulatory services, which is outpatient care people receive without being admitted to a hospital
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including counseling and psychotherapy
  • Prescription drugs
  • Rehabilitation services and devices, including anything that helps people with injuries, disabilities or chronic conditions gain or recover mental and physical skills
  • Laboratory services
  • Preventive and wellness services, such as shots and screening tests for everything from high cholesterol and diabetes to cancer and sexually transmitted diseases
  • Pediatric services

All health plans offered through the online exchange, as well as other plans offered directly by insurers or through agents, must cover the 10 services without charging a co-payment or co-insurance, even if a patient hasn't met a yearly deductible.

The 10 benefits are the minimum requirements for all plans in the marketplace, but some plans may offer additional coverage.

 Credits

Renee Chou, Reporter
Matthew Burns, Web Editor

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