Essential Health Benefits: if you have an ACA plan, you get them…for now. So what are they? See our Glossary for the definition that includes poor rock climbing — or read on for the longer version and info about what’s happening with them now.
Essential Health Benefits are one of the most-argued provisions of the ACA. They are ten services that each ACA plan is required to provide to consumers. Here they are:
- Ambulatory patient services: Being seen in a doctor’s office, clinic, or same-day (“outpatient”) surgery center. In other words, services for when you’re able to walk into the doctor’s office.
- Emergency services: Heading to the E.R. These apply when you are facing disability or death if you’re not treated immediately.
- Hospitalization: Care from doctors, nurses, and other hospital staff; lab tests; medications you’re given; and room and board.
- Maternity and newborn care: Prenatal services, labor, delivery, post-delivery, and care for newborn babies.
- Mental health services and addiction treatment: Evaluation for and diagnosis/treatment of mental health conditions or substance dependence and addiction.
- Prescription drugs: Yup. They have to cover your meds.
- Rehabilitative services and devices: Recovering skills (physical therapy after a stroke); habilitative services (speech therapy for children); and devices that help you gain back skills lost to injury, disability, or a chronic condition (walkers).
- Lab services: Oh, those blood draws. Testing to help a doctor diagnose an injury, illness, or condition or to monitor how well a treatment is working.
- Preventive services, wellness services, and chronic disease treatment: Counseling; preventive care like physicals, immunizations, and screenings; and care for chronic conditions.
- Pediatric services: Care for kids. Well-child visits, recommended vaccines and immunizations, two routine dental exams, an eye exam, and corrective lenses each year.
Recently, we've been updating you on the possible repeal of the Affordable Care Act (a.k.a. “Obamacare,” or the ACA). This gets more complex by the minute, but the upshot is that approval of President Trump’s healthcare bill (the thing that would replace the ACA) has been delayed because there simply aren’t enough votes to pass it.
Which leads to the multi-billion dollar question: What’s going to happen to EHBs?
People in support of an ACA repeal argue that getting rid of EHBs would cut the price tag on health insurance for everyone. They say that EHBs force people to buy coverage for stuff they don’t want. (Why should someone who doesn’t have kids yet pay for child dental coverage?)
On the other hand, those who oppose the repeal believe Congress was on the right track to begin with, not just because covering people’s basic needs is the right thing to do, but because improving everyone’s health will reduce healthcare costs long term. (Just to be clear, we’re talking about fundamental care people need, not elective procedures — think preventing and treating sickness, not tummy tucks and teeth whitening.)
Although the immediate threat to these EHBs seems to have passed, dismantling Obamacare and dropping these benefits is still is a very real possibility. We’ll let you know what happens.
Agree that it’s important to monitor this issue and understand what an EHB repeal would mean for you? Join us.