10 essential health benefits covered by marketplace health insurance plans

Actualizado: 2 oct 2020

Surfing through all health insurance options can get confusing very fast. We want to make things easier for you, so if you are elegible for a Marketplace plan, you can count with these 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, 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 drugs

  • 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).

Essential health benefits are minimum requirements for all Marketplace plans. Specific services covered in each broad benefit category can vary based on your state’s requirements. Plans may offer additional benefits, including:

  • Dental coverage

  • Vision coverage

  • Medical management programs (for specific needs like weight management, back pain, and diabetes)

When comparing plans, you’ll see exactly what each plan offers.


Also covered: Preventive care & coverage for pre-existing conditions.

Marketplace plans cover a set of preventive services, like shots and screening tests, at no cost to you when delivered by a provider in your plan’s network.

Please consider that no insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started, including pregnancy.


We prepared a quick infographic so you never forget the esencial care covered by marketplace health insurance plans:



If you have any doubts regarding health insurance we are happy to help. Contact us at 806-508-003 or info@yourhealthnlife.com8

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