The ten things every ACA plan must cover
Every ACA Marketplace plan must cover ten categories of essential health benefits. That’s what makes Marketplace coverage “comprehensive” — and what private and short-term plans may not fully include.
ACA plans must cover: 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 wellness services (plus chronic disease management), and pediatric services including dental and vision for children.
Preventive care — screenings, vaccines, annual visits — is covered at no out-of-pocket cost when you stay in network, even before you meet your deductible.
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Not fully. Short-term and fixed indemnity plans aren’t required to cover all ten categories and may exclude things like maternity, mental health, or pre-existing conditions. That lower coverage is the trade-off for their lower price — we make it clear before you decide.