What are Essential Health Benefits under the ACA?

• A. They are optional service packages chosen by each insurer.
• B. They are only required for employer-sponsored plans.
• C. They are a comprehensive set of health services that the ACA requires plans to offer.
• D. They are a comprehensive health services that health plans are not required to offer.

Answer: (C)

Essential Health Benefits are a comprehensive package of health services that the ACA requires most health plans to cover. This baseline ensures plans offered in the individual and small-group markets (and non-grandfathered plans in other markets) include a standard set of services across ten categories, such as preventive care, emergency services, hospitalization, maternity and newborn care, mental health and substance use treatment, prescription drugs, rehabilitative and habilitative services, laboratory services, pediatric care, and preventive/wellness services. States define the exact scope by selecting a benchmark plan, and some older “grandfathered” plans may be exempt from certain requirements. The crucial point is that these benefits are mandatory, not optional add-ons, which is why the correct choice describes them as a comprehensive set of health services the ACA requires plans to offer.