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Essential Health Benefits under the ACA

Starting this year, the Affordable Care Act (ACA) requires that health plans offered in the individual and small-group markets offer essential health benefits within at least ten categories:

  • ambulatory patient services
  • emergency services
  • hospitalization
  • maternity and newborn care
  • mental health and substance use disorder services, including behavioral health treatment
  • prescription drugs
  • rehabilitative and habilitative services and devices
  • laboratory services
  • preventive and wellness services and chronic disease management
  • pediatric services, including oral and vision care


Visit the sidebar for further resources on the Affordable Care Act (ACA).



Ewoldt, L. L. (2013). Healthcare reform: resolve to increase your knowledge in 2014.American Nurses Today, 9(1), 8-11.

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Helpful Resources on Healthcare Reform

Centers for Medicaid & Medicare Services. Medicare Provider Charge Data.

Kaiser Health News. Interactive Chart: Bonuses and Penalties for U.S. Hospitals

Leapfrog Group. Leapfrog Hospital Survey. Hospital Compare: Hospital Readmission Reduction Program Hospital Compare: Total Performance Score Information (Value Based Purchasing)