What are essential health benefits in health insurance?

Essential health benefits refer to a specific set of categories of healthcare services that must be covered by health insurance plans in the individual and small group markets as mandated by the Affordable Care Act (ACA). This requirement ensures that all health insurance policies provide a baseline level of coverage that addresses a range of health needs, which helps improve access to necessary care for all individuals.

The categories of essential health benefits include services such as emergency services, hospitalizations, maternity and newborn care, mental health and substance use disorder services, and preventive and wellness services, among others. By establishing these standards, the ACA aims to protect consumers from inadequate health plans that may not provide sufficient coverage for critical health services.

This requirement is foundational in promoting comprehensive and equitable healthcare, ensuring that individuals can receive necessary medical care without facing exorbitant costs or being denied coverage for essential services.