Essential health benefits
Updated for plan year 2026
In plain terms
Essential health benefits are ten categories of care that every marketplace plan and most individual and small-group plans must cover. They include outpatient care, emergency services, hospitalization, pregnancy and newborn care, mental health and substance use treatment, prescription drugs, rehabilitative services and devices, lab tests, preventive and chronic-disease management, and pediatric services including dental and vision for children. Plans can differ in cost and network, but none can drop these categories or cap their annual or lifetime dollar value.
A plain example
You compare two very different plans, a low-premium bronze and a high-premium gold. Both must still cover the same ten categories: an ER visit, a maternity stay, mental-health therapy, and your prescriptions are all in scope on either plan. What changes between them is how much you pay for that care, not whether it's covered at all.
Why it matters
Essential health benefits are the floor that makes marketplace plans comparable: you can choose on price and network knowing the core categories of care are covered either way. They're also why a marketplace plan differs from a short-term plan, which can leave these categories out.
A common point of confusion
Covered doesn't mean free. Essential health benefits guarantee the categories of care are included, but you still pay your deductible, copays, and coinsurance for most of them. Only preventive care is required to be covered at no cost in network.