Understanding Essential Health Benefits

What Will My Health Insurance Cover?

Beginning in 2014, the Affordable Care Act required that health insurance plans, inside and outside of the government’s Health Insurance Marketplace, cover a number of different health-related categories known as essential health benefits. These plans must cover ten areas of service

Essential health benefits include:

1. Ambulatory patient services (outpatient care you get without being admitted to a hospital)
2. Emergency services
3. Hospitalization
4. Pre and post natal care
5. Mental health and substance use disorder services, including behavioral health treatment (including counseling and psychotherapy)
6. Prescription drugs
7. Rehabilitative and habilitative services and devices (services and devices that help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services (including dental and vision)

Will My Health Insurance Cover Anything That is Not an Essential Benefit?

It’s possible. Essential health benefits are simply the minimum coverage requirements for health insurance companies. Varying plans may cover a number of additional benefits, such as birth control, breastfeeding and dental coverage, which are not required under the essential health benefits.

While these essential health benefits are required for most health insurance plans, each state may have additional coverage requirements.

Note: “grandfathered plans” are not required to cover the essential health benefits, though many do.

Health Insurance Providers Raleigh, NC

The Wooten Agency is available to help you find the plan that is right for you. Whether you are under the age of 65 and in need of health insurance, or are a Medicare recipient in need of additional coverage, the Wooten Agency is happy to help.

Contact the Wooten Agency in Cary, NC today to learn more about essential health benefits, or to receive a complimentary health insurance consultation!

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Regardless of whether you purchase a policy or not, we are always happy to help in any way we can.

Client Testimonials

What Are Essential Health Benefits? | Wooten Agency

  • "This is a family-owned business who cares about their potential clients. I was looking for help with health insurance and even though it turns out I don't need new health insurance at this time, I feel compelled to write a review because of how thorough Brendan was. He was very knowledgeable and easy-going. He didn't seem pushy at all and listened to everything I had to say. He made sure he was getting all the information correct. I would recommend this agency for any insurance needs." - Doug C.
  • "I sought help from Wooten Agency; Ed, along with Nancy, took the bull by the horns and sorted things out for us very quickly. Shortly thereafter Ginny took over. She is definitely most qualified as a plan selector for Medicare plans and issues related to Medicare. My appreciation to Crystal for the gracious way she always responds to telephone calls and makes every effort to ensure one is not forgotten. And Dana....the one contact we had was enough to find out you are similarly inclined to help a client." - Frank V.
  • "You [Aaron] have been so helpful, and you have all taken a personal interest in my individual and specific questions in order to make the best insurance choices for my needs. Thank you all! I look forward to working together in the future months and years." - Susan H.

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