10 Essential Health Benefits Insurance Plans Must Cover Under the Affordable Care Act 

Achieving affordable health care that covers all Americans has been a goal of politicians and policymakers for decades. In 2010, the Affordable Care Act (ACA) was signed. This law requires that all individual and small group plans cover 10 essential health benefits, including hospitalization, maternity, mental health services, prescription drugs, ambulatory services, emergency, laboratory services, rehabilitative services, pediatric services, and preventive services. Therefore, you have to consider these factors as you compare health insurance plans.


The hospital services required to be covered before any deductibles are met, including essential health benefits under the Affordable Care Act. These benefits cover both inpatients and outpatients regardless of their health conditions.




The Affordable Care Act requires all plans to include certain preventative services. Certain preventative services are already mandated through the United States Preventative Services Task Force, which include Pap smears, mammograms, immunizations, and breastfeeding counseling. Women can also get free birth control under the Affordable Care Act as part of their basic benefits package.

Mental Health Services

Mental health coverage is another important benefit of buying health insurance through the Affordable Care Act, and it is a birthright that all Americans deserve. Research has shown that many people face mental health problems who are not getting the help they need. The Affordable Care Act requires all major medical plans to have mental health coverage available for Americans. If you have a mental illness, you can no longer be denied coverage for these conditions under the ACA.

Prescription Drugs

The Federal Food, Drug, and Cosmetic Act protects you from being denied coverage for prescription drugs, but the Affordable Care Act goes even a step further by requiring your health insurance plan to cover prescription drugs. It also requires that prescription drugs are not only covered but that they are available at a reasonable price. As of January 2010, recipients could get out of paying an annual deductible if they paid their monthly premium.

Ambulatory Services

These services include the type of surgery that a patient would receive the same day they visit the hospital. The ACA requires that insurance plans cater to such services to promote good health and access to quality and affordable care.

Emergency care

Insurance companies will not require prior approval for emergencies such as heart attacks or visiting an out-of-network hospital. In the event of an emergency, an individual is expected to rush to the nearest hospital to seek quick medical help. This prevents the worsening of the medical condition, and insurance plans should cater to such emergencies. If you are feeling sick and need a doctor, have been in a car accident, and require medical assistance, the care provided must be covered by the ACA healthcare insurance plan. You may not be denied coverage for any reason under the ACA.

Laboratory services

The ACA plan requires insurance to cover lab tests that the doctors might run to aid in the diagnosis process. These tests are necessary because they promote good health by facilitating the correct diagnosis. 

Rehabilitative Services

This section covers the services and devices needed in helping people with chronic health conditions and those required to regain or improve skills after an injury.

Paediatric Services

The ACA requires all major medical plans to include pediatric care in the list of essential health benefits. If you have a child under the age of 19, then you will be able to get free basic health services through Medicaid, which includes pediatric care. This helps people in reducing health insurance monthly cost.

Preventive Services

This type of care covers all the routine visits to the doctor, such as vaccinations and annual examinations. However, you need to check your benefits well before visiting the doctor to ensure that your insurance plan covers the exact service. Some plans will not cover all the services carried out at the doctor’s office and will not offer you ways to save money fast.

The next time you go insurance shopping, make sure that you look for these benefits and ask yourself if the plan provides them for you and your family. If not, you may be paying too much for an inferior policy, yet you could be spending the same amount on a highly beneficial policy. Insurry.com can help you compare your options and find the best one for you and your family.

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