10 Essential health benefits (EHBs): Everything you need to know

A major win of the Affordable Care Act was the inclusion of Essential Health Benefits (EHBs) in all ACA-compliant health insurance plans. Most broadly, Essential Health Benefits are a way to describe ten categories of services that these plans must cover. All Marketplace plans (aka Obamacare or ACA plans) cover the Essential Health Benefits.

To see prices and available Marketplace plans that cover the 10 essential health benefits, enter your zip code below. Because of all the available subsidies and cost-sharing reductions, most pay under $21/month for health coverage.

You can also call (872) 228-2549 for help enrolling.

Essential Health Benefit Categories

These ten EHB categories are:

• Ambulatory patient services (outpatient care you get without being admitted to a hospital)
• Emergency services
• Hospitalization (like surgery and overnight stays)
• Pregnancy, maternity, and newborn care (both before and after birth)
• Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
• Prescription drug coverage
• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

All ACA-compliant plans must also include birth control coverage and breastfeeding coverage. This means that any plan that any health care plan you buy off the health insurance Marketplace, either from HealthCare.gov or HealthSherpa, comes with a guarantee that your plan will include coverage for all of the above types of services, even though details on specific services may vary by plan.  ACA-compliant plans also cover coronavirus testing.

Preventive Care

One key thing to keep in mind is that any of the above Essential Health Benefits that are considered preventive care, versus diagnostic care, are also covered at no-cost thanks to the Affordable Care Act. There are 65 free healthcare services guaranteed by the Affordable Care Act in any ACA-compliant plan. This is true of any plan you purchase off the Marketplace, through HealthSherpa, or that you have through an employer who offers ACA-compliant benefits. Preventive care is not always covered by health sharing ministries, short-term insurance, or indemnity plans.

Grab our guide to preventive care to learn more.

Please remember that you will need to see an in-network provider to receive these preventive services at no cost to you. 

To see health insurance plans and prices and enroll, go to healthsherpa.com.

What are all of my health insurance options?

You have several coverage options for plans that cover all of the essential health benefits.

1. 1. Marketplace/“Obamacare” plan. You can enroll in a Marketplace health insurance plan, also known as Obamacare or Affordable Care Act insurance. See plans and prices here.
   2. Medicaid. You also may be eligible for Medicaid, depending on your income. You can see if you’re eligible and apply here.
   3. COBRA. If you’ve been laid off recently, you usually have the option of COBRA, where you pay the full premium of the same insurance your employer purchased for you. COBRA is typically much more expensive than Marketplace insurance, but it allows you to continue the coverage you already had. Learn more about comparing COBRA with Obamacare health insurance.
   4. Medicare. Once you turn 65, you’re eligible for Medicare. Call us to enroll at (855) 677-3060.

When can I enroll in Marketplace health insurance?

Anyone who’s eligible can enroll in Marketplace health insurance during Open Enrollment, which runs from November 1 to January 15 in most states. If it’s outside of that period of time, you’ll need a Qualifying Life Event, such as losing your insurance or having a child, to qualify.

Grab our guide to enrolling in health insurance to learn more.