February 3, 2010

Essential Health Benefits

The Patient Protection and Affordable Care Act (PPACA, or just ACA) is a US law that was passed in 2010. The goal of the law is to make sure all Americans can get health care at a price that is within their means. The ACA calls for US states to make health plans available to the public for which the state pays a part of the cost. These “subsidized” health plans must help to cover at least 10 kinds of health care service.

These 10 types of health care have come to be called the “essential health benefits” (EHBs). The types of care that make up the list of EHBs are as follows:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management, and
  10. Pediatric services, including oral and vision care

Note that, the last item on the list calls for kids’ dental care. Sadly, adult dental care did not make the list at all. Yet, while dental care for adults is not called out in the EHBs, each state does have the choice of whether or not it will include adult dental care in its benchmark health plan.

States Have a Choice about How They Treat the EHBs

Under the ACA, each state can choose how to define the EHBs that they will offer to the public. It is up to each state to choose which type of plan to use as a benchmark. The types include small group, federal employee, state employee, or commercial HMO.

States may put kids’ oral care benefits in their health plans. They may also keep this type of care as a standalone product. What is more, states have the choice to define oral care for adults as part of the EHBs for their plans or not. Thus, they may roll adult oral care benefits into health plans. Or they may offer them as detached parts of the state’s benefits package.