10 Essential Health Benefits In Every Marketplace Plan

What Are Essential Health Benefits?

Essential Health Benefits or EHB's is the name given to the 10 service categories that plans must cover to be a part of the Marketplace (also known as ACA plans or Obamacare plans).

What Are The 10 EHB Categories?

All plans offered in the Marketplace (ACA plans or Obamacare plans) cover:

1. Ambulatory patient services (outpatient 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. Preventative and wellness services and chronic disease management

10. Pediatric services, including oral and vision care

Call (608)313-4816 for help and to better understand what is included in these ten categories.

What Other Coverage Is Included?

All plans must also include birth control coverage, breastfeeding coverage, and coronavirus testing coverage to be compliant with the Marketplace. Specifics will vary by plan or carrier however all plans will include coverage for the above services or categories.

Plans may also include in additional services and coverage however to be compliant with the MArkeplace they cannot exclude the above categories of service.

Preventive Care Through The Marketplace

Preventative care services that are listed above are covered at no cost. In plans outside of the Marketplace, preventive care services are not always 100% covered. For example, short term insurance plans,health sharing ministry plans, and indemnity plans do not normally cover preventaive care services 100%.

There are 65 healthcare services that are included 100% free through ACA plans (aka Obamcare plans or Marketplace plans). These free preventative services are offered through the in-network providers listed on the ACA compliant plans. 

Click here to view health insurance plans, premiums and costs, and to enroll in new coverage.

What Are My Options?

For health insurance plans that will cover all of the 10 Essential Health Benefits (EHB's) guaranteed, you have several options:

1. Marketplace/“Obamacare”/ACA plans

2. Medicaid

3. Medicare

4. COBRA

When Can I Enroll?

Anyone who is eligible can enroll in Marketplace health insurance during Open Enrollment. Open enrollment is from Nov 1 to January 15 (in most states). If the timing of your health insurance purchase or your search is outside of the annual open enrollment, to qualify you need a Qualifying Life Event to open a Special Enrollment Period (an SEP) to apply for Marketplace coverage.

What Is A Qualifying Life Event?

​A qualifying life event is an event that ​opens up a ​Special ​Enrollment ​Period for an individual or ​a ​family to purchase health insurance outside of the annual open enollment period​ through the Marketplace​.

​Call (608)313-4816​ or click here if you have had a QLE recently, to find out if you have a QLE, or need to learn more,​