Health Insurance
Essential Health Benefits
Essential Health Benefits ensure that all ACA-compliant plans cover a baseline of care including emergency services, mental health, maternity, and prescription drugs.
Last reviewed: May 2026 · Editorial methodology
Definition
Essential Health Benefits (EHBs) are ten categories of healthcare services that the ACA mandates all non-grandfathered individual and small group market health plans — including marketplace plans — must cover without annual or lifetime dollar limits. The ten EHB categories are: (1) ambulatory patient services, (2) emergency services, (3) hospitalization, (4) maternity and newborn care, (5) mental health and substance use disorder services, (6) prescription drugs, (7) rehabilitative and habilitative services and devices, (8) laboratory services, (9) preventive and wellness services, and (10) pediatric services including oral and vision care. The specific services within each category are defined by each state's benchmark plan, meaning there is variation in the exact benefits covered across states. Large group employer plans and self-funded plans are not required to cover all EHBs, though they cannot impose lifetime or annual limits on EHBs they do cover. Preventive services under EHBs — including vaccinations, cancer screenings, and contraception — must be covered with no cost-sharing.
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Cover Forge USA Editorial Team
Editorial Lead
This article was researched and written by the Cover Forge USA editorial team against federal sources (NAIC, CMS, FEMA, DOL, SSA, state DOIs) and standard policy forms. Bylines organize content by topic — they do not assert individual licensure. See our editorial-policy for details.
Reviewed 2026-06-14
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