The Affordable Care Act guarantees that all Marketplace health plans include a set of 10 essential health benefits ACA requirements. These benefits ensure that every individual and family gets comprehensive, reliable coverage — not just the basics. Knowing what these benefits are helps you compare plans, avoid gaps in care, and protect your household financially.
Understanding the 10 essential health benefits ACA rules mandate will help you feel confident heading into Open Enrollment 2026, which begins November 1, 2025.
Every ACA plan is required to cover these 10 categories of care:
1. Ambulatory patient services
Also called outpatient care, this includes doctor visits, urgent care, and same-day procedures that don’t require a hospital stay.
2. Emergency services
All ACA plans cover ER care, and you can’t be charged more for an out-of-network ER visit during a true emergency.
3. Hospitalization
Coverage includes inpatient hospital stays, surgeries, nursing care, and other services you may need while admitted.
4. Maternity and newborn care
Prenatal visits, labor and delivery, and newborn care are always included. This is one of the 10 essential health benefits ACA requires, ensuring growing families are protected.
5. Mental health and substance use disorder services
Coverage includes counseling, therapy, inpatient treatment, and substance use disorder care. Mental health coverage must be equal in strength to medical coverage.
6. Prescription drugs
Every ACA plan covers prescription medications. Insurers must cover at least one drug in every essential category and class.
7. Rehabilitative and habilitative services and devices
This includes physical and occupational therapy, speech therapy, and medical devices that help with recovery or daily living.
8. Laboratory services
Blood tests, diagnostic labs, and screenings fall under this benefit — a core part of keeping families healthy.
9. Preventive and wellness services, plus chronic disease management
Screenings, vaccines, and annual checkups are included at no cost when provided in-network. This is one of the most family-friendly 10 essential health benefits ACA requires.
10. Pediatric services, including oral and vision care
Children’s coverage must include dental and vision benefits. While adult dental and vision aren’t mandatory, some plans do offer them.
Why the 10 essential health benefits ACA requirements matter
Before the ACA, many individual plans excluded services like maternity care or mental health treatment. By establishing the 10 essential health benefits ACA rules, the law ensures every Marketplace plan provides a strong foundation of care.
This means whether you’re choosing a Bronze, Silver, or Gold plan, you’ll know these benefits are always included. The differences between plans come down to costs — monthly premiums, deductibles, copays, and coinsurance.
Protecting your family with these benefits
The 10 essential health benefits ACA mandates are designed to protect families from the unexpected. From an emergency room visit to preventive care that helps your kids stay healthy, these services form the safety net that makes health coverage truly comprehensive.
How ICT Insurance Group can help you choose the right ACA plan
Knowing what the 10 essential health benefits ACA plans provide is only the first step. Choosing the right plan requires comparing networks, checking prescription coverage, and weighing out-of-pocket costs.
At ICT Insurance Group, we help families in Kansas and 29 other states navigate Marketplace coverage. Our licensed agents explain your options in plain language, help you qualify for subsidies that reduce costs, and guide you to the plan that best fits your needs.
Get started today
Open Enrollment for 2026 coverage begins November 1, 2025. Don’t wait until the deadline — call ICT Insurance Group at (316) 440-6111 or request a free quote online.
With the 10 essential health benefits ACA plans provide to protect families, and expert help from ICT Insurance Group, you can feel confident knowing your coverage supports your health and your budget.
