Published: June 23, 2026.
EHB stands for essential health benefits. ACA Marketplace plans must cover ten categories including ambulatory care, emergency services, hospitalization, maternity, mental health, prescription drugs, rehab, lab services, preventive care, and pediatric services including dental and vision.
Key Takeaways
- EHB stands for essential health benefits. ACA Marketplace plans must cover ten categories including ambulatory care, emergency services, hospitalization, maternity, mental health, prescription drugs, rehab, lab services, preventive care, and pediatric services including dental and vision.
- EHB sets the floor for what qualified health plans cover, but it does not make all plans identical. Networks, drug formularies, prior authorization rules, and cost sharing still vary widely within the same metal tier.
- Pediatric dental and vision may be embedded in the medical plan or offered as a separate purchase depending on state rules. Brokers with dependent heavy households should confirm pediatric EHB delivery in the SBC.
- Essential health benefits apply to individual and small group ACA plans. Large group and grandfathered plans follow different rules.
EHB sets the floor for what qualified health plans cover, but it does not make all plans identical. Networks, drug formularies, prior authorization rules, and cost sharing still vary widely within the same metal tier.
Pediatric dental and vision may be embedded in the medical plan or offered as a separate purchase depending on state rules. Brokers with dependent heavy households should confirm pediatric EHB delivery in the SBC.
Essential health benefits apply to individual and small group ACA plans. Large group and grandfathered plans follow different rules.
Related field notes
Related glossary terms
FAQ
Common broker questions about this term.
Do all metal tiers include the same EHBs?
Yes on the benefit categories. Metal tier describes how much of expected costs the plan pays on average, not which categories are covered.
Are elective procedures EHB?
Cosmetic and purely elective services are generally excluded. Medically necessary services within the ten categories must be covered without annual or lifetime dollar limits.
Where do brokers document EHB for clients?
The Summary of Benefits and Coverage lists key cost sharing and covered services. Pair the SBC with formulary and provider network checks for the drugs and doctors the client actually uses.
