What is the function of essential health benefits under the ACA?

Under the Affordable Care Act (ACA), essential health benefits serve a fundamental role in establishing a baseline of coverage that all health insurance plans must include. This requirement ensures that consumers receive a comprehensive range of services, promoting access to necessary healthcare. The essential health benefits include categories such as outpatient care, emergency services, hospitalization, maternity and newborn care, mental health services, prescription drugs, preventive services, and pediatric services.

By mandating that these specific services be covered, the ACA aims to protect consumers from insurance plans that might skimp on vital health care needs, thus enhancing the overall accessibility and affordability of health care. This framework also helps to prevent discriminatory practices by insurers based on pre-existing conditions or inadequate coverage, thereby ensuring that essential medical services are available to all individuals, regardless of their health status or income level.

The design of essential health benefits represents a significant step toward creating a more equitable health care system by ensuring that all policyholders have access to essential medical services without facing steep out-of-pocket costs or exclusions.