Affordable Care Act

What Are the Essential Health Benefits of Obamacare?

Updated on February 13, 2020


Individual health insurance plans haven’t all been standardized by the government, so policies may vary quite a bit. Prudent insurance shoppers should compare various plans to find the best mix of benefits and premiums for their own health-care needs and budgets. At the same time, the Affordable Care Act (ACA) requires insurers to offer certain essential health benefits in every major medical & qualified plan, so this ensures that all plans have some consistent benefits.

The importance of the ten essential health benefits

The ten essential health benefits help consumers know what they can expect to find in all qualified plans (meaning plans that are approved under Obamacare’s standards). These essential health benefits also ensure that policy owners can enjoy broad coverage and protection from some of the kinds of things that tend to generate large medical bills.
Before the ACA (Obamacare) was passed in 2010, many consumers were disappointed when they realized that their medical plans did not cover services like maternity or mental health services only after they got bills in the mail. Insurance shoppers should always take the time to consider their budgets, health-care needs, and the benefits that different policies offer before choosing a plan. The fact that all Marketplace plans have to offer the same essential health benefits can make the task of comparing health insurance a bit easier.

What are the essential health benefits of Obamacare?

In addition to the ten essential health benefits of Obamacare for adults, children get additional essential benefits. These include dental and vision coverage. While some Obamacare plans may offer vision, dental, or other coverage for adults, they are not part of the ten essential benefits. Families and individuals can also buy stand-alone insurance with other benefits to supplement their Marketplace health insurance.

Do all health insurance plans include these ten essential health benefits?

American consumers can still buy health insurance outside of the federal or state marketplaces.  Products like packaged health insurance plans might not meet the minimum requirements to satisfy ACA rules for mandated major medical insurance. At the same time, they may cost less than qualified plans just because they don’t need to offer the ten essential benefits.

These kinds of medical plans might also help with typical medical expenses and ensure access to health-care providers. Some of them use the same kinds of networks that PPO and HMO plans do, so plan members may get discounted services as well. Some examples of the kinds of medical plans included in packaged health insurance might include short-term health insurance, accident policies, and prescription discount plans.
These policies sold outside the Marketplace won’t keep people from paying fines for not having qualified major medical health insurance and may not offer the essential health benefits. So, they usually aren’t considered a long-term solution. They could provide a good option for people who are in any of these situations:

  • Are between jobs (group health insurance from work)
  • Are in the country for a short time
  • Have missed Open Enrollment for Obamacare

How to learn more about the ten essential health benefits

This eHealth resource offers more detailed information about the Obamacare essential health benefits and other requirements for qualified medical plans. Besides the essential health benefits, qualified plans also have to have an actuarial value of at least 60 percent. According to the Kaiser Family Foundation, this means that Bronze plans that meet minimum requirements must pay at least 60 percent of anticipated health-care expenses for an average family.
Consumers can use eHealth to search for Obamacare insurance, short-term health insurance, and a variety of other medical plans in their area. Our zip code search form includes both Marketplace and non-Marketplace options to help satisfy the needs of every individual, family, and small business.

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