The Affordable Care Act: A Guide to Essential Health Benefit (EHB) Coverage

Introduction

The Affordable Care Act (ACA) is a landmark health care reform law that has had a significant impact on the way Americans access and pay for health care. One of the most important components of the ACA is the Essential Health Benefits (EHB) provision, which requires health insurance plans to cover a comprehensive set of services that meet the needs of the majority of Americans.

What are Essential Health Benefits (EHBs)?

EHBs are a set of ten categories of health care services that must be covered by all health insurance plans offered through the Health Insurance Marketplace. These categories include:

Ambulatory patient services
Emergency services
Hospitalization
Pregnancy, maternity, and newborn care
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services

Importance of EHBs

EHBs ensure that all Americans have access to a comprehensive set of health care services, regardless of their age, health status, or income level. By requiring health insurance plans to cover these essential services, the ACA helps to reduce the risk of financial hardship for families facing a medical emergency or chronic illness.

How EHBs are Determined

The specific services that are included in the EHB package are determined by each state. States have the flexibility to tailor EHBs to meet the unique needs of their populations. However, all state-determined EHB packages must meet certain federal standards.

Ensuring Access to Essential Health Benefits

There are a number of ways to ensure that you have access to EHBs. You can:

Purchase a health insurance plan through the Health Insurance Marketplace.
Get health insurance through your employer.
Qualify for Medicaid or Medicare.

If you have health insurance, you can check your plan’s Summary of Benefits and Coverage (SBC) to see what services are covered. The SBC is a standardized document that provides a clear and concise summary of your plan’s benefits and costs.

Conclusion

Essential Health Benefits are a key component of the Affordable Care Act. They ensure that all Americans have access to a comprehensive set of health care services, regardless of their age, health status, or income level. By requiring health insurance plans to cover these essential services, the ACA helps to reduce the risk of financial hardship for families facing a medical emergency or chronic illness.