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| Meta Title | Find out what Marketplace health insurance plans cover | HealthCare.gov | ||||||||||||||||||
| Meta Description | Learn about the essential health benefits that all private health insurance plans offered in the Health Insurance Marketplace® must cover. | ||||||||||||||||||
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| Boilerpipe Text | Health benefits & coverage
More info
What Marketplace health insurance plans cover
Preventive health services
Coverage for pre-existing conditions
Dental coverage in the Marketplace
Birth control benefits
Breastfeeding benefits
Mental health & substance abuse coverage
All plans offered in the Marketplace cover these
10 essential health benefits
:
Ambulatory patient services (outpatient care you get without being admitted to a hospital)
Emergency services
Hospitalization (like surgery and overnight stays)
Pregnancy, maternity, and newborn care
(both before and after birth)
Mental health and substance use disorder services
, including behavioral health treatment (this includes counseling and psychotherapy)
Prescription drugs
Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
Laboratory services
Preventive and wellness services
and chronic disease management
Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
Additional benefits
Plans must also include the following benefits:
Birth control coverage
Breastfeeding coverage
Essential health benefits are
minimum requirements
for all Marketplace plans. Specific services covered in each broad benefit category can vary based on your state’s requirements. Plans may offer additional benefits, including:
Dental coverage
Medical management programs (for specific needs like weight management, back pain, and diabetes)
When comparing plans, you’ll see exactly what each plan offers.
More answers | ||||||||||||||||||
| Markdown | [Skip to main content](https://www.healthcare.gov/coverage/what-marketplace-plans-cover/#main)
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- [Español](https://www.cuidadodesalud.gov/es/coverage/what-marketplace-plans-cover/)
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- [Get Coverage](https://www.healthcare.gov/get-coverage)
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- [Find out if you can enroll now](https://www.healthcare.gov/screener)
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- [Marketplace tips](https://www.healthcare.gov/quick-guide/one-page-guide-to-the-marketplace)
- [How to apply & enroll](https://www.healthcare.gov/apply-and-enroll/how-to-apply)
- [Picking a plan](https://www.healthcare.gov/choose-a-plan/comparing-plans)
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- Make changes
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- Save money
- [Find out if you'll save](https://www.healthcare.gov/lower-costs)
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- [Extra savings](https://www.healthcare.gov/lower-costs/save-on-out-of-pocket-costs)
- [High Deductible Health Plans](https://www.healthcare.gov/high-deductible-health-plan)
- How to...
- [Use your coverage](https://www.healthcare.gov/using-marketplace-coverage)
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- [Find local help](https://www.healthcare.gov/find-assistance)
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- [Appeal a Marketplace decision](https://www.healthcare.gov/marketplace-appeals)
- [Pay premium & check coverage status](https://www.healthcare.gov/apply-and-enroll/complete-your-enrollment)
- More details if you...
- [Just had a baby or adopted](https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period#household)
- [Are under 30](https://www.healthcare.gov/young-adults)
- [Have (or offered) job-based insurance](https://www.healthcare.gov/have-job-based-coverage)
- [Are self-employed](https://www.healthcare.gov/self-employed)
- [Are unemployed](https://www.healthcare.gov/unemployed)
- [Qualify for Medicare](https://www.healthcare.gov/medicare)
- Taxes
- [Health coverage & your taxes](https://www.healthcare.gov/taxes)
- [Tax Form 1095-A](https://www.healthcare.gov/tax-form-1095)
- ['Reconcile' tax credit](https://www.healthcare.gov/taxes-reconciling)
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[Get Coverage](https://www.healthcare.gov/get-coverage/)[Keep or Update Your Plan](https://www.healthcare.gov/have-coverage/)
See Topics
## Enroll in health insurance
- [Find out if you can enroll now](https://www.healthcare.gov/screener)
- [Enrollment dates & deadlines](https://www.healthcare.gov/quick-guide/dates-and-deadlines/)
- [Marketplace tips](https://www.healthcare.gov/quick-guide/one-page-guide-to-the-marketplace/)
- [How to apply & enroll](https://www.healthcare.gov/apply-and-enroll/how-to-apply/)
- [Picking a plan](https://www.healthcare.gov/choose-a-plan/comparing-plans/)
- [Dental coverage](https://www.healthcare.gov/coverage/dental-coverage/)
- [Medicaid & CHIP](https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/)
## Make changes
- [Reporting income/household changes](https://www.healthcare.gov/reporting-changes/why-report-changes/)
- [Changing plans](https://www.healthcare.gov/keep-or-change-plan/)
- [Cancel a plan](https://www.healthcare.gov/reporting-changes/cancel-plan/)
## Save money
- [Find out if you'll save](https://www.healthcare.gov/lower-costs/)
- [Save on your premiums](https://www.healthcare.gov/lower-costs/save-on-monthly-premiums/)
- [Extra savings](https://www.healthcare.gov/lower-costs/save-on-out-of-pocket-costs/)
- [High Deductible Health Plans](https://www.healthcare.gov/high-deductible-health-plan/)
## How to...
- [Use your coverage](https://www.healthcare.gov/using-marketplace-coverage/)
- [Estimate income](https://www.healthcare.gov/income-and-household-information/)
- [Find local help](https://www.healthcare.gov/find-assistance/)
- [Submit documents](https://www.healthcare.gov/tips-and-troubleshooting/uploading-documents/)
- [Appeal a Marketplace decision](https://www.healthcare.gov/marketplace-appeals/)
- [Pay premium & check coverage status](https://www.healthcare.gov/apply-and-enroll/complete-your-enrollment/)
## More details if you...
- [Just had a baby or adopted](https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period#household)
- [Are under 30](https://www.healthcare.gov/young-adults/)
- [Have (or offered) job-based insurance](https://www.healthcare.gov/have-job-based-coverage/)
- [Are self-employed](https://www.healthcare.gov/self-employed/)
- [Are unemployed](https://www.healthcare.gov/unemployed/)
- [Qualify for Medicare](https://www.healthcare.gov/medicare/)
## Taxes
- [Health coverage & your taxes](https://www.healthcare.gov/taxes/)
- [Tax Form 1095-A](https://www.healthcare.gov/tax-form-1095/)
- ['Reconcile' tax credit](https://www.healthcare.gov/taxes-reconciling/)
[Browse all topics](https://www.healthcare.gov/topics/)
Featured
Find out if you qualify for a Special Enrollment Period
[Open Enrollment is over, but you may still be able to get or change health coverage for this year.](https://www.healthcare.gov/coverage-outside-open-enrollment/your-options/)
[Get Answers](https://www.healthcare.gov/get-answers/)
# Health benefits & coverage
[Email this pageEmail](mailto:?subject=What%20Marketplace%20health%20insurance%20plans%20cover&body=https%3A%2F%2Fwww.healthcare.gov%2Fcoverage%2Fwhat-marketplace-plans-cover%2F)
Print this pagePrint
## More info
- [What Marketplace health insurance plans cover](https://www.healthcare.gov/coverage/what-marketplace-plans-cover/)
- [Preventive health services](https://www.healthcare.gov/coverage/preventive-care-benefits/)
- [Coverage for pre-existing conditions](https://www.healthcare.gov/coverage/pre-existing-conditions/)
- [Dental coverage in the Marketplace](https://www.healthcare.gov/coverage/dental-coverage/)
- [Birth control benefits](https://www.healthcare.gov/coverage/birth-control-benefits/)
- [Breastfeeding benefits](https://www.healthcare.gov/coverage/breast-feeding-benefits/)
- [Mental health & substance abuse coverage](https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/)
More info
## What Marketplace health insurance plans cover
All plans offered in the Marketplace cover these **10 essential health benefits**:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- [Emergency services](https://www.healthcare.gov/using-marketplace-coverage/getting-emergency-care/)
- Hospitalization (like surgery and overnight stays)
- [Pregnancy, maternity, and newborn care](https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-get-pregnant/) (both before and after birth)
- [Mental health and substance use disorder services](https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/), including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- [Preventive and wellness services](https://www.healthcare.gov/coverage/preventive-care-benefits/) and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
## Additional benefits
Plans must also include the following benefits:
- [Birth control coverage](https://www.healthcare.gov/coverage/birth-control-benefits/)
- [Breastfeeding coverage](https://www.healthcare.gov/coverage/breast-feeding-benefits/)
Essential health benefits are **minimum requirements** for all Marketplace plans. Specific services covered in each broad benefit category can vary based on your state’s requirements. Plans may offer additional benefits, including:
- [Dental coverage](https://www.healthcare.gov/coverage/dental-coverage/)
- Vision coverage
A health benefit that at least partially covers vision care, like eye exams and glasses. All plans in the Health Insurance Marketplace® include vision coverage for children. Only some plans include vision coverage for adults.
Refer to glossary for more details.
- Medical management programs (for specific needs like weight management, back pain, and diabetes)
When comparing plans, you’ll see exactly what each plan offers.
## More answers
## Are the benefits the same in each state?
Generally, yes. But some states require insurers to cover additional services and procedures. Even within the same state, there can be small differences.
When you compare plans in the Marketplace, you'll see the specific benefits each plan offers.
## What if I need a specific treatment that's not on this list?
Plans may cover other services. When you compare plans, you’ll see more detailed information about what’s covered. If you want to find out if a particular service is covered, call the plan.
## Do all types of Marketplace plans cover essential health benefits?
Yes. Any plan shown in the Marketplace includes these essential health benefits. This is true for all plan categories (all “metal levels,” including Catastrophic plans) and all plan types (like HMO and PPO).
## Do I have to pay deductibles and copayments for essential health benefits?
Generally, yes. All Marketplace plans have
deductibles
How much you’ll pay for certain covered services and items each year before your plan starts to pay (except free preventive services).
Refer to glossary for more details.
,
copayments
A fixed amount you pay for a plan-covered service, like \$30.
Refer to glossary for more details.
, and other
out-of-pocket costs
Costs you pay when you get a service covered by your plan (like deductibles, co-pays, and coinsurance) plus all costs for any items not covered by your plan
Refer to glossary for more details.
that apply to most covered services.
Some
preventive services
Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.
Refer to glossary for more details.
are free, and some plans cover other services without out-of-pocket costs.
## Do I get these benefits if my company is self-insured?
It depends. Large employers who "self-insure” — meaning they pay employees' health care costs directly — **don't** have to provide essential health benefits. But many do. Check with your employer to find out if it’s self-insured and what services are covered.
## Are abortion services covered by Marketplace plans?
Sometimes, and plans may have different restrictions. Some offer no coverage or coverage with restrictions. In some cases abortion services cannot be paid for with federal dollars (these are known as “non-Hyde” abortion services).
Contact each plan to learn about its abortion coverage.
## Do I get these benefits if I have a grandfathered plan?
It depends. Many
grandfathered plans
An individual health insurance policy purchased on or before March 23, 2010. These plans weren’t sold through the Marketplace, but by insurance companies, agents, or brokers. They may not include some rights and protections provided under the Affordable Care Act.
Refer to glossary for more details.
cover essential health benefits, but they’re not required to. To be sure, check with your employer or health plan.
Learn more about [grandfathered health plans](https://www.healthcare.gov/health-care-law-protections/grandfathered-plans/).
[Email this pageEmail](mailto:?subject=What%20Marketplace%20health%20insurance%20plans%20cover&body=https%3A%2F%2Fwww.healthcare.gov%2Fcoverage%2Fwhat-marketplace-plans-cover%2F)
Print this pagePrint
[Back to top](https://www.healthcare.gov/coverage/what-marketplace-plans-cover/#top)
## Resources
- [About the Affordable Care Act](https://www.hhs.gov/healthcare/index.html)
- [Regulatory and Policy Information](https://www.cms.gov/marketplace/about/oversight)
- [For Navigators, Assisters & Partners](https://www.cms.gov/marketplace/in-person-assisters/information-partners)
- [For Agents and Brokers](https://www.cms.gov/marketplace/agents-brokers/resources)
- [For the Media](https://www.cms.gov/about-cms/contact/newsroom)
- [For Researchers](https://www.healthcare.gov/health-and-dental-plan-datasets-for-researchers-and-issuers/)
- [For States](https://www.cms.gov/marketplace/states/state-marketplace-resources)
- [Information in other languages](https://www.healthcare.gov/language-resource/)
## Connect with us
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Health Insurance Marketplace® is a registered trademark of the Department of Health & Human Services.
An official website of the U.S. Centers for Medicare & Medicaid Services. | ||||||||||||||||||
| Readable Markdown | Health benefits & coverage
## More info
- [What Marketplace health insurance plans cover](https://www.healthcare.gov/coverage/what-marketplace-plans-cover/)
- [Preventive health services](https://www.healthcare.gov/coverage/preventive-care-benefits/)
- [Coverage for pre-existing conditions](https://www.healthcare.gov/coverage/pre-existing-conditions/)
- [Dental coverage in the Marketplace](https://www.healthcare.gov/coverage/dental-coverage/)
- [Birth control benefits](https://www.healthcare.gov/coverage/birth-control-benefits/)
- [Breastfeeding benefits](https://www.healthcare.gov/coverage/breast-feeding-benefits/)
- [Mental health & substance abuse coverage](https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/)
All plans offered in the Marketplace cover these **10 essential health benefits**:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- [Emergency services](https://www.healthcare.gov/using-marketplace-coverage/getting-emergency-care/)
- Hospitalization (like surgery and overnight stays)
- [Pregnancy, maternity, and newborn care](https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-get-pregnant/) (both before and after birth)
- [Mental health and substance use disorder services](https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/), including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- [Preventive and wellness services](https://www.healthcare.gov/coverage/preventive-care-benefits/) and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
## Additional benefits
Plans must also include the following benefits:
- [Birth control coverage](https://www.healthcare.gov/coverage/birth-control-benefits/)
- [Breastfeeding coverage](https://www.healthcare.gov/coverage/breast-feeding-benefits/)
Essential health benefits are **minimum requirements** for all Marketplace plans. Specific services covered in each broad benefit category can vary based on your state’s requirements. Plans may offer additional benefits, including:
- [Dental coverage](https://www.healthcare.gov/coverage/dental-coverage/)
- Medical management programs (for specific needs like weight management, back pain, and diabetes)
When comparing plans, you’ll see exactly what each plan offers.
## More answers | ||||||||||||||||||
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