10 Marketplace health benefits
All Marketplace health insurance plans must cover 10 categories of essential health benefits. Essential health benefits are minimum requirements for all Marketplace plans. Specific services covered in each category may be different based on your state's requirements.
10 covered 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
- Services like physical therapy, occupational therapy, and speech therapy
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (doesn’t include adult dental or vision coverage)
Plans must also include birth control and breastfeeding coverage. Some plans may offer dental and
A health benefit that at least partially covers vision care, like eye exams and glasses. All plans in the Health Insurance Marketplace® include vision coverage for children. Only some plans include vision coverage for adults.
Refer to glossary for more details.
