Essential Health Benefits (EHBs) are the 10 categories of care that all ACA-compliant health insurance plans are required to cover. Before the ACA, insurers could sell plans that excluded major categories of care. EHBs ensure that every Marketplace plan covers the same baseline of services.
The 10 Essential Health Benefit categories:
EHBs must be covered, but the cost-sharing for each service varies by plan. “Covered” doesn’t mean free — it means the service counts toward your deductible and out-of-pocket maximum. Only preventive services have a $0 cost-sharing requirement.
All ACA Marketplace plans and most employer plans must cover EHBs. Grandfathered plans, short-term health plans, and some limited benefit plans are exempt. If you’re buying off-Marketplace or considering a short-term plan, verify that it covers the full range of essential benefits before enrolling.
No. EHBs set a floor for what must be covered, but plans can — and do — cover additional services beyond the 10 categories. Many plans include dental, vision, and wellness programs as added benefits on top of the EHB baseline.
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