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The Health Insurance Marketplace: What Does It Cover?

All private health insurance plans offered in the Marketplace will offer the same set of essential health benefits. These are services all plans must cover. The essential health benefits include at least the following items and services:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization, such as surgery
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices, such as services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services

Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side by side in the Marketplace.

U.S. Centers for Medicare & Medicaid Services, HealthCare.gov. (n.d.). What does Marketplace health insurance cover? Retrieved May 16, 2017, from https://www.healthcare.gov/

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