10 Essential Benefits Your Health Insurance Plan Must Cover
All private health plans offered in the Marketplace must cover these 10 essential health benefits regardless of the plan category and type. (Note: These are the minimum requirements for all Marketplace plans. Specific services covered in each broad benefit category can vary based on your state’s requirements.)
Covered essential health benefits
- Ambulatory patient services
- Emergency services
- Hospitalization
- Pregnancy, maternity, and newborn care (pre and post birth)
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Other services may be available to you
- Marketplace plans include breastfeeding and birth control coverage.
- Your plan may also offer dental and vision coverage and medical management programs (for specific needs like weight management, back pain, and diabetes).
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About the Author: Sophia Chen
Sophia Chen writes about auto, home, health, life, and Medicare insurance to help U.S. consumers compare policies and make informed coverage decisions. She focuses on breaking down complex insurance topics into clear, practical guidance that addresses real-life needs like choosing a plan during a life change or understanding premium updates. With a background in consumer finance research and a commitment to unbiased education, she brings clarity to the insurance shopping process. Her work on InsuranceShopping.com empowers readers to navigate their options confidently, whether they are exploring Medicare Advantage plans for 2026 or looking for the best health insurance in their local area.
