The Ten Essential Health Benefits (“EHBs”) in the ACA

By admin on April 30, 2018 | Listed under Heathcare Reform | Leave a comment |

We have posted on these EHB’s before.  But the 10 (ten) essential health benefits are the cornerstone to the ACA.      (HHS on the ACA)

Under the new rules set out by the ACA all new major medical health insurance policies must provide ten essential health benefits (“EHBs”). These are minimum coverage requirements that all insurance plans must meet. The ten EHBs that all plans must cover are:

  1. Outpatient Care: Treatment for illness or injury at a doctor’s office, clinic, or other outpatient facility.
  2. Inpatient Care: Treatment for illness or injury in a hospital.
  3. Emergency Care: Treatment for emergency illness or injury, for example, in a hospital’s emergency room (ER).
  4. Prescription Drug Coverage: Medications prescribed by your doctor.
  5. Maternity & Newborn Care: Care for mothers and babies before and after birth.
  6. Mental health & substance abuse: Counseling, psychotherapy and behavioral health treatment for mental illness or substance abuse (e.g. alcohol or drug abuse).
  7. Rehabilitation: Treatment for people with disabilities, injuries or chronic illness to help them recover physical or mental skills.
  8. Lab Tests: Laboratory tests associated with treatment by a doctor or hospital, for example, blood tests.
  9. Preventative Services: Checkups, vaccines, and counselings designed to keep you healthy. These are actually required to be free for all plans. For a more detailed discussion of what exactly is covered, see this fact sheet from the Kaiser Family Foundation.  (KFF)
  10. Pediatric (Child) Services: Dental and vision care for children, including visits to dentists and things like prescription eyeglasses.
See the above list of the 10 EHB’s on HealthCare.gov

Note that just because plans are required to provide all these essential health benefits doesn’t mean that these treatments will be cheap. Health insurance plans can have individual deductibles as high as $6,350 and family deductibles as high as $12,700, meaning that if you go to the hospital you could end up paying that much on your own before the insurance company starts to pay anything. Individuals and families that qualify for cost-sharing reduction are in luck as they will have lower deductibles and out of pocket maximums on silver plans – see this article for more about that.

Note we are looking to work with Health Sherpa to make it easier to purchase on marketplace plans. (as of 08/2014)

Health Sherpa 

LINKS

HHS –Key features of ACA    (from the Health & Human Services (HHS) , part of our government)

HHS – Time line for the ACA

HHS  – Texas info 

Gov’t – Link to the ACA law (document)

KFF – Summary of the ACA ( a very reputable source)  and the full text of the law, once again.

KFF – Search of   ” Essential Health Benefits’

Wikipedia – on the ACA  

Wikipedia – Acronyms in healthcare

Wikipedia – Time line for the ACA (provisions)

 

 

 

 

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