Home Articles A Brief Guide to the ACA’s Essential Health Benefits

A Brief Guide to the ACA’s Essential Health Benefits


When former President Barack Obama signed the Affordable Care Act (ACA) into law in 2010, it became the U.S.’s most comprehensive healthcare reform bill since Lyndon B. Johnson established the Social Security Act Amendments in 1965.

In the years since its passage, the ACA has granted millions of Americans access to affordable health insurance plans. By 2016, the number of uninsured individuals in the U.S. had about halved. Thanks to the ACA, more people can benefit from preventative care, keeping them from racking up exorbitant bills for extended hospital stays.

In recent years, former President Trump had altered the ACA’s key aspects, eliminating individual mandates and stopping payments of cost-sharing subsidies to insurance companies. However, under the Biden administration, experts anticipate the president will attempt to protect and expand the ACA.

Rumored proposals include creating a public health insurance option and lowering the Medicare eligibility age from 65 to 60. Whether president Biden will present proposals has yet to be seen, but the ACA has already extended much-needed, affordable healthcare coverage to millions of Americans.

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Despite ACA health plans’ benefits, rising premiums and narrow provider networks have driven many Americans to enroll in non-ACA-compliant programs. While short-term insurance plans don’t often cover preventative care or pre-existing conditions, healthy Americans gain access to flexible coverage, additional providers, and extra features like prescription benefits. However, ACA plans do provide extensive protection and cover essential health benefits.

Preventive and wellness visits

One essential benefit the ACA covers is preventative and wellness visits. Through the ACA, services like shots, screening tests, annual physicals, and preventive care are entirely free of cost to patients. Before arranging your yearly check-up, ensure that you aren’t scheduling your doctor’s visit within 365 days of your previous exam. Most plans only cover one annual physical every 365 days, so scheduling your check-up too soon can result in receiving an expensive bill.

Mental health treatment

Under the ACA, mental and behavioral health services are also considered an essential health benefit. Treatments like psychotherapy and counseling must be covered, in addition to substance abuse treatment. Before the ACA, the Mental Health Parity Act of 1996 and the Mental Health Parity and Addiction Equity Act of 2008 required large-group employer insurance plans to offer parity between mental health treatments and other medical and surgical services.

However, individual and small-group plans were exempt from this congruity requirement, and insurance companies often denied patients coverage based on their mental health history. The ACA mandated equality across all insurance plans and also ended spending limits, allowing for improved care.

Rehabilitative services

If you’ve broken a bone or sustained a temporary injury, the ACA requires that your insurance plan covers the services and equipment needed to recover. These include physical and occupational therapy, speech-language pathology, and other treatments that help you regain functions you may have lost due to an injury. In addition to rehabilitation, the ACA also mandates coverage for treating chronic diseases like multiple sclerosis, arthritis, cognitive dysfunctions, and diabetes.

Maternity care

All ACA plans extend to maternity and newborn care coverage, falling under the preventative medicine branch. Maternity care includes medical check-ups and screening tests to ensure you and your baby are healthy as you carry to term. Before the ACA, maternity care was rarely covered by insurance plans, with the National Women’s Law Center reporting only 12% of individual plans included coverage for maternity care. Pregnancy was also considered a pre-existing condition that automatically excluded expectant mothers from receiving coverage in all but five states. Now, ACA-qualified plans must cover before and after birth care.

The bottom line

While the ACA isn’t a perfect piece of legislation, there’s no doubt it’s extended coverage to vulnerable populations, improving the quality of life of those previously uninsured. Through mandated health benefits, the ACA has kept millions of Americans healthy as they search for treatment and support.