Individual and small group health plans are required by the Affordable Care Act to cover essential health benefits like maternity, mental health, preventive, and pediatric dental care. This provision is one of the more well-liked aspects of the law, as it applies to people who do not have traditional job-based coverage. As they are known, essential health benefits (often abbreviated as EHB) have been the subject of numerous proposals from members of Congress and the administration of President Donald Trump that would either do away with them entirely or severely weaken their effectiveness.
The essential health benefits (EHB) criteria ensure that everyone in the individual and small group health insurance marketplaces has access to comprehensive coverage that truly covers the services they seek. These ten categories categorize the important advantages to one's health:
Because of the Patient Protection and Affordable Care Act, people are no longer limited in the amount of coverage they can receive for these fundamental medical services.
Patients receive additional health advantages and a reduced amount of financial strain as a result of the mandate in the Affordable Care Act that essential health care be covered without annual dollar restrictions. Patients frequently encountered unexpected dollar limits on services that were technically covered by their plans, forcing them to pay the remainder of the costs. Although plans before the ACA stated that they covered many of these services, actual coverage was often inconsistent. Patients frequently faced the necessity of paying the remaining costs.
Additionally, this new definition of coverage that is embedded in the Affordable Care Act (ACA) assures that plans cover critical services that are now excluded from coverage by a large number of plans, including the following:
People who struggle with mental health or substance abuse disorders will have the assurance of knowing that their plan must cover their requirements, and that their coverage for mental health services must be at least as all-encompassing as their coverage for medical and surgical services. This will give them the peace of mind that they need to focus on getting better.
When a woman becomes pregnant, she will have the peace of mind of knowing that she is covered under her health insurance plan's maternity benefits.
When most plans currently only cover services to regain abilities, people who have developmental and intellectual problems will benefit from habilitative services that help them learn, keep, or improve functional skills that will assist them in learning, keeping, or improving functional skills.
Long periods of time passed while the people of the United States waited for comprehensive coverage of services that are critical to their overall health. The mandate placed on insurance providers by the ACA to provide coverage for these fundamental medical services represents a step in the right direction toward providing all citizens of the United States with all-encompassing medical protection.