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essential benefits

What are essential benefits?

Since 2014, under the Affordable Care Act, all new individual and small-group health insurance policies (including those sold in the ACA’s health insurance exchanges and off-exchange) must cover essential health benefits for all enrollees.

The ACA defines ten essential health benefits:

Prior to 2014, it was common for individual market plans in many states to not include maternity benefits, prescription drug coverage, or mental health/substance abuse coverage. But since 2014, all new individual major medical plans have included these benefits — along with the rest of the essential health benefits — for all enrollees.

Grandmothered and grandfathered plans are not required to cover the ACA’s essential health benefits. Large group plans are also not required to cover essential health benefits.