This includes medical services you receive without being admitted to a hospital. Ambulatory services cover visits to doctors, specialists, and outpatient clinics, as well as preventive care, such as routine check-ups and screenings. Whether you need to see a primary care physician for a routine visit or a specialist for a specific health issue, this benefit ensures that you receive the necessary care outside of a hospital setting.

Hospitalization coverage includes all services you receive during a hospital stay, such as surgery, overnight stays, and treatments. The ACA ensures that these services are covered, helping to reduce the financial burden of significant medical events like surgeries, intensive care, and lengthy hospitalizations.

The ACA mandates coverage for maternity and newborn care, which includes prenatal visits, labor and delivery, and postnatal care for both mother and child. This benefit ensures that expectant mothers receive comprehensive care throughout their pregnancy, during childbirth, and after delivery, promoting the health and well-being of both mother and baby.

Mental health and substance use disorder services are considered essential under the ACA. This includes coverage for counseling, psychotherapy, inpatient mental health care, and treatment for substance use disorders. The ACA also requires that these services be covered on par with physical health services, eliminating annual or lifetime caps on mental health care.

Rehabilitative services help individuals recover skills lost due to injury, illness, or disability, such as physical therapy after surgery. Habilitative services help individuals gain or maintain skills needed for daily living, often used for children with developmental disabilities. The ACA covers therapies like physical therapy, occupational therapy, and speech therapy, as well as medical devices such as walkers, wheelchairs, and prosthetics.

Coverage under the ACA includes essential diagnostic tests and screenings, such as blood tests, urine tests, and tissue biopsies. These services are vital for diagnosing conditions, monitoring health, and guiding treatment plans. Routine screenings, such as cholesterol checks and cancer screenings, are often covered as preventive services with no out-of-pocket costs.

For children under 18, the ACA mandates coverage for a range of pediatric services, ensuring that children receive comprehensive care as they grow. This includes routine pediatrician visits, immunizations, and developmental screenings. Additionally, pediatric dental and vision care are included, covering services such as regular dental check-ups, cleanings, fillings, eye exams, and corrective lenses, ensuring that children have access to necessary oral and vision care.

In addition to these Essential Health Benefits, the ACA includes several other protections and benefits designed to improve access to healthcare:

• No Lifetime or Annual Limits: ACA-compliant plans cannot impose lifetime or annual limits on essential health benefits, ensuring that you receive the care you need without worrying about hitting a coverage cap.
• Pre-existing Condition Coverage: Insurance companies cannot deny you coverage or charge you higher premiums based on pre-existing conditions, ensuring that you can get the care you need regardless of your health history.
• Free Preventive Care: Many preventive services are covered at no additional cost to you, helping you stay healthy without worrying about copays or deductibles.