What Are the 10 Essential Health Benefits?

On this page

• The 10 essential health benefits
• Which plans have to cover them
• Why coverage varies by state
• Children’s dental and vision vs. adults
• What usually isn’t included
• Plans that don’t follow these rules
• How to check what a plan covers
• Frequently asked questions

The 10 essential health benefits

HealthCare.gov lists these 10 categories, which every Marketplace plan covers:

1. Outpatient care: care you get without being admitted to a hospital, like doctor visits.
2. Emergency services.
3. Hospitalization: surgery and overnight stays, for example.
4. Pregnancy, maternity and newborn care: before and after birth.
5. Mental health and substance use disorder services: including counseling and psychotherapy.
6. Prescription drugs.
7. Rehabilitative and habilitative services and devices: care that helps people with injuries, disabilities or chronic conditions gain or recover mental and physical skills.
8. Laboratory services.
9. Preventive and wellness services and chronic disease management.
10. Pediatric services, including oral and vision care.

Marketplace plans also have to cover birth control and breastfeeding support. These 10 categories are a floor. A plan can add more, such as adult dental or vision coverage, or programs for weight management, back pain or diabetes. For details on pregnancy coverage, see maternity coverage explained.

Which plans have to cover them

The rules apply to non-grandfathered plans in the individual and small-group markets, whether you buy on the Marketplace or directly from an insurer. In most states, small group means employers with up to 50 workers (up to 100 in California, New York and Vermont).

Large-group plans and self-funded employer plans don’t have to cover all 10 categories. But if they cover an essential health benefit, they can’t put an annual or lifetime dollar limit on it. They also still have to cover recommended preventive care at no cost to you, unless the plan is grandfathered.

Lifetime dollar limits on essential health benefits are banned in all individual and job-based plans, even grandfathered ones. Yearly dollar limits are banned in most plans, with an exception for grandfathered individual policies. Plans can still put dollar limits on services that aren’t essential health benefits, and they can cap the number of visits for things like physical therapy.

Why coverage varies by state

The law sets the broad categories. Each state picks an essential health benefits benchmark plan that spells out what each category includes, and plans sold there must offer benefits that are substantially equal to it.

That’s why a service like physical therapy might come with a different number of covered visits in one state than in another. States can also update their benchmark plans. For 2026, federal regulators approved changes to the benchmark plans in Alaska, the District of Columbia and Washington, and for 2027 they approved a change in Colorado. For more on how state rules differ, see health insurance regulations by state.

Children’s dental and vision vs. adults

Pediatric dental and vision care are part of the 10 categories. Under federal rules, that coverage has to last until at least the end of the month a child turns 19.

• Vision: All Marketplace plans include vision coverage for children. Only some include it for adults.
• Dental: Children’s dental coverage must be available to you, either inside a health plan or as a separate dental plan, but you don’t have to buy it.
• Adults: Dental and vision coverage for adults isn’t an essential health benefit, so it depends on the plan. Separate dental plans can make adults wait before some services are covered.

See does Obamacare cover dental and does Obamacare cover vision for your options.

What usually isn’t included

Federal rules say a plan can’t count these as essential health benefits:

• Routine dental care for adults
• Routine eye exams for adults
• Long-term custodial nursing home care
• Orthodontia that isn’t medically necessary

Cosmetic procedures that aren’t medically necessary are usually excluded too. A plan may still cover some of these items as an extra benefit, but nothing requires it.

Plans that don’t follow these rules

• Short-term plans: They aren’t required to cover essential health benefits. They often leave out maternity care, mental health care, preventive care and prescription drugs, usually exclude pre-existing conditions and can have annual and lifetime caps. See short-term health insurance.
• Health care sharing ministries: These aren’t insurance and aren’t regulated by state insurance departments. They don’t have to cover essential health benefits and can have annual and lifetime caps. See health care sharing ministries.
• Grandfathered plans: Individual policies bought on or before March 23, 2010 don’t have to cover essential health benefits or free preventive care. You can’t buy a new one.

How to check what a plan covers

• Summary of Benefits and Coverage: ACA-compliant and job-based plans have to provide one. Its “Excluded Services & Other Covered Services” section lists what the plan won’t pay for and some extras it does cover.
• Plan comparison tools: When you compare plans on HealthCare.gov, you can see what each plan offers.
• The full plan document: It has the details the summary leaves out, like visit limits and which services need prior authorization.
• Your state’s benchmark plan: The federal government posts each state’s benchmark plan documents if you want to see the baseline.

If a plan you’re looking at is sold off the Marketplace and isn’t labeled as ACA-compliant, ask the seller directly whether it covers all 10 categories.

Every Marketplace plan covers all 10 essential health benefits. Compare plans and prices by ZIP code.

Frequently asked questions

Do all health plans have to cover the 10 essential health benefits?

No. Almost all individual and small-group plans must. Large-group and self-funded employer plans don’t have to cover every category, and short-term plans and health care sharing ministries don’t have to cover them at all.

Is dental an essential health benefit?

For children, yes. For adults, no, so adult dental coverage depends on the plan or a separate dental policy.

Are essential health benefits the same in every state?

The 10 categories are the same everywhere. What each category includes depends on your state’s benchmark plan.

Is preventive care an essential health benefit?

Yes. It’s one of the 10 categories, and most plans must also cover recommended screenings and shots at no cost when you use an in-network provider. See what preventive care is free.

This article is general information, not insurance or legal advice. What’s covered within each category depends on your state’s benchmark plan and the plan you choose. Last reviewed October 2026.