10 Essential health benefits (EHBs): Everything you need to know

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The amended Patient Protection and Affordable Care Act, also known as ACA or Obamacare 2010 passed state legislation that included private insurance. The essential health benefits (EHBs) included in the mandatory order form the crucial parts of health insurance Anaheim (California).

ACA or Obamacare sanctioned that all non-grandfathered health plans in the individual and small-group private medical insurance programs in the US must have a basic package of EHBs. Moreover, the purchase should be through the ACA. Fortunately, if you live in Anaheim, you can benefit from affordable private coverages that carry these benefits. Not to forget, these financial aids are compulsory for all consumers purchasing health insurance coverage in the individual/small group market.

Today, we shall highlight and discuss these essential health benefits (EHBs) under the ACA for a clearer picture:

What Are the EHBs under the Affordable Care Act for Private Insurances?

There are a total of 10 essential health benefits (EHBs) that you shall receive after purchasing private coverages. Each of them can provide an optimum financial umbrella for health and medical emergencies.

  • Outpatient Care or Ambulatory Patient Services

Ambulatory care includes all healthcare benefits to patients not admitted to the hospital. These include doctor’s consultations, medical tests, diagnosis, and required treatments.

X-rays and physical checkups are a part of this outpatient or ambulatory care coverage under the policies.

  • Emergency Services

Patients that need immediate hospitalization, surgery, or operations are considered to be in the need of emergency services. These include all treatments inside the emergency rooms.

  • Inpatient care or hospitalization

Inpatient care coverages kick in when the insured takes formal admission into a hospital due to medical emergencies. It needs two or more days to stay in the clinic for it to activate. The coverages of your insurance include the facility fees, caregiver remuneration, and more.

  • Maternity and Newborn Care

Under the Affordable Care Act, newborn care insurance falls under the health insurance Anaheim quotas. Maternity coverages for women include all medical expenses for them and their children. Moreover, the policy stays active before, during, and after childbirth. Of course, it can reimburse all maternity expenses up to a predefined limit.

  • Mental health and substance use disorder services

As the insured, you can submit insurance claims for mental health treatment. The inclusion of mental health coverage helps various people who suffer from medical issues such as depression, anxiety, bipolar disorder, and more.

If you submit the claim, it can reimburse mental health treatment, behavioral health treatment counseling, and psychotherapy. It is affordable insurance with planned benefits.

  • Prescription Drugs

You can submit a claim for prescription drugs under your health insurance coverages. And this is as registered prescription medications are now under the federal government classification. Meaning, this means one from each group should be under coverage.

  • Rehabilitative and habilitative services and devices

Various kinds of injuries and diseases require rehabilitative therapies. Registering for therapy sessions can help many patients get back on their feet. These are beneficial for injuries, disabilities, and chronic illnesses. Not to forget, these therapies include physical therapy, occupational therapy, speech therapy, and more.

  • Laboratory services

Lab tests for medical emergencies also form a part of the health insurance coverage in the US. Meaning, you can opt to submit claims for diagnostic testing, efficacy testing, and certain preventative screenings.

  • Preventive and wellness and chronic disease management

Various medical wellness services fall under health insurance programs, such as diet counseling, Type 2 diabetes screenings, colorectal cancer screening, and immunization vaccines. Patients looking to improve their immunity and overall health can benefit from insurance coverage and save more.

  • Pediatric services

Last but not least, pediatric services cover dental and vision care, along with vaccinations, immunizations.

The Clear Differences between Health Benefits and Minimum Essential Coverages

One should not confuse between “essential health benefits” and “minimum essential coverage.” Minimum Essential Coverage is the minimum amount of coverage that one needs with the individual health insurance mandate. On the other hand, EHBs are a set of benefits that qualified health plans (QHPs) must provide.

Additionally, minimum Essential Coverage has a low threshold; many types of coverage that do not provide essential health benefits are still considered minimum coverage.


According to the Center for American Progress, “approximately 20 million people have received health insurance as a result of the ACA. Moreover, between 2012 and 2013, and 2015 and 2016, the uninsurance rate among new mothers fell by 41% as a result of the ACA.”

Therefore, make sure to opt for ACA-mandated health insurance in Anaheim, for comprehensive medical coverage benefits.