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Marketplace coverage & essential health benefits

July 21, 2022

There are 10 categories of services — called essential health benefits — that all private health insurance plans offered in the Health Insurance Marketplace® must cover.

What are the 10 essential health benefits?

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (like surgery and overnight stays)
  • Pregnancy and newborn care (both before and after birth)
  • Mental health and substance use disorder services, including behavioral health treatment, counseling, and psychotherapy
  • 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 (this doesn’t include adult dental or vision coverage)

What else does the Marketplace cover?

  • Marketplace plans must also offer birth control and breastfeeding coverage.
  • Some Marketplace plans may have dental and vision coverage too, but these benefits aren’t required.
  • Call your plan to check if it covers a particular service.

Get more information on what Marketplace health insurance plans cover.

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Resources

  • US Small Business Administration
  • Shelby County TN Business Tax Division

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