Essential Health Benefits

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Health Care Benefits
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Health Care Benefits

Health care benefits are the treatments, items, or services that an insurance plan covers. Under the Affordable Care Act, health insurance plans are required to offer comprehensive coverage that takes care of the most basic health needs. In Medicaid or CHIP, covered benefits and excluded services are defined in state program rules. These are referred to as essential health benefits. There are 10 categories that essential health benefits fall into:


  1. Ambulatory patient services or outpatient care

  2. ​​Emergency services

  3. Hospitalization

  4. Maternity and newborn care

  5. Mental health and substance use disorder services

  6. ​Prescription drugs

  7. Rehabilitative services

  8. ​Laboratory services

  9. Preventive and wellness services

  10. Pediatric services


​Each plan covers these essential health benefits in slightly different ways, be sure to read all details of the plan before making a decision. Health plan details can be reviewed by speaking to an insurance company representative or visiting their websites, meeting with a Health Care navigator, or accessing a website like Healthnet, which provides summary of benefits and coverage for a number of plans.