What are Essential Health Benefits?
Essential Health Benefits (EHB) are a set of health care service categories that must be covered by certain plans, especially those offered through the Health Insurance Marketplace under the Affordable Care Act (ACA). Understanding these benefits is crucial for consumers seeking comprehensive coverage.
Categories of Essential Health Benefits
- Ambulatory Patient Services: Outpatient care that does not require an overnight stay.
- Emergency Services: Services for sudden and severe medical conditions requiring immediate attention.
- Hospitalization: Coverage for inpatient hospital stays, including surgeries and other treatments.
- Maternity and Newborn Care: Includes prenatal, childbirth, and postnatal care.
- Mental Health and Substance Use Disorder Services: Includes behavioral health treatment for mental health conditions and addiction.
- Prescription Drugs: Coverage for medications prescribed by a healthcare provider.
- Rehabilitative and Habilitative Services: Services that help individuals regain skills or functions after illness or injury.
- Laboratory Services: Diagnostic testing and laboratory procedures.
- Preventive and Wellness Services: Routine healthcare like screenings and check-ups to maintain health and prevent illness.
- Pediatric Services: Includes dental and vision care for children.
Importance of EHB
Essential Health Benefits ensure that individuals and families receive necessary health care regardless of their financial situation, promoting overall public health and reducing long-term healthcare costs. When choosing a health insurance plan, it's essential to verify that it covers these benefits to ensure comprehensive health coverage.