The Affordable Care Act requires every individual and small-group health plan sold in the United States to cover 10 broad categories of care, known as essential health benefits (EHBs). Congress wrote the list into Section 1302 of the ACA specifically so that shoppers could no longer buy a plan that quietly excluded maternity care, mental health treatment, or prescription drugs, the way many pre-2014 individual policies did. In 2026, the 10 EHB categories still apply to every ACA-compliant plan sold on HealthCare.gov, a state-based marketplace, or directly from an insurer off-exchange.
CoveredUSA lists all 10 essential health benefit categories below, explains which plan types must cover them, and shows what happens when a plan is exempt, such as short-term insurance. For the mental health piece specifically, see does the ACA cover mental health treatment. If a preexisting condition is part of your decision, see does the ACA cover preexisting conditions.
Coverage Breakdown
| Plan Type | Must Cover All 10 EHBs? | What This Means in 2026 | Example |
|---|---|---|---|
| ACA Marketplace individual/small-group plan | Yes (required) | Every metal tier, Bronze through Platinum, includes all 10 categories; tiers differ only in cost-sharing, not in what is covered | A Bronze plan bought on HealthCare.gov in 2026 covers maternity care just like a Platinum plan |
| Medicaid expansion (Alternative Benefit Plan) | Yes (required) | Adults covered under Medicaid expansion get an Alternative Benefit Plan aligned to the state's EHB benchmark, so all 10 categories apply | A 2026 Medicaid expansion enrollee gets mental health and substance use treatment at parity with medical care |
| CHIP | Yes | State CHIP programs must offer benefits equivalent to the EHB categories for enrolled children, plus dental and vision | A child on CHIP in 2026 gets pediatric dental and vision at no extra premium |
| Short-term limited-duration insurance (STLDI) | No (exempt) | Federal law does not classify short-term plans as ACA-compliant, so insurers can exclude maternity, mental health, or prescription coverage and deny preexisting conditions | A 2026 short-term plan can legally exclude coverage for a pregnancy that begins after enrollment |
| Grandfathered plans and large self-funded (ERISA) employer plans | Partial | Grandfathered plans (in place before March 23, 2010, and unchanged) and large self-funded plans are not bound by the EHB mandate, though most voluntarily cover comparable benefits | A large 2026 self-funded employer plan may still cap physical therapy visits, something an ACA marketplace plan cannot do to rehabilitative services |
The essential health benefit mandate applies to the individual and small-group markets, Medicaid Alternative Benefit Plans, and CHIP. It does not apply to Medicare, large-group fully insured plans, self-funded ERISA plans, short-term limited-duration insurance, or grandfathered plans.
Source: HealthCare.gov Essential Health Benefits, CMS EHB Benchmark Plans, 42 U.S.C. §18022 (ACA §1302)
Direct Answer: Yes, 10 Essential Health Benefits Are Required in 2026
Yes. Every ACA-compliant individual and small-group plan sold in 2026, whether purchased on HealthCare.gov, a state marketplace, or directly from an insurer, must cover all 10 essential health benefit categories: outpatient care, emergency services, hospitalization, maternity and newborn care, mental health and substance use treatment, prescription drugs, rehabilitative services, lab services, preventive care, and pediatric services. Short-term and grandfathered plans are exempt.
The 10 ACA Essential Health Benefit Categories
Section 1302 of the Affordable Care Act, implemented by CMS regulations at 45 CFR 156.110, defines 10 statutory categories that every ACA-compliant plan must include in 2026. States pick a benchmark plan that determines the exact scope of services within each category, but no state can drop a category or set a benchmark below the federal floor.
- Ambulatory patient services: doctor visits, outpatient surgery, and urgent care that do not require an overnight hospital stay
- Emergency services: emergency room care, including out-of-network ER visits, at in-network cost-sharing levels
- Hospitalization: surgery, inpatient nursing care, and any service needed while admitted to a hospital
- Maternity and newborn care: prenatal visits, labor and delivery, and care for the newborn
- Mental health and substance use disorder services: therapy, inpatient psychiatric care, and addiction treatment, subject to mental health parity rules
- Prescription drugs: at least one drug per U.S. Pharmacopeia drug category and class on the plan formulary
- Rehabilitative and habilitative services and devices: physical therapy, speech therapy, and durable medical equipment for injuries, disabilities, or chronic conditions
- Laboratory services: bloodwork, diagnostic testing, and screening labs ordered by a provider
- Preventive and wellness services and chronic disease management: annual wellness visits, vaccines, and cancer screenings covered at $0 cost-sharing in 2026
- Pediatric services, including oral and vision care: dental checkups, eyeglasses, and vision exams for enrollees under 19
ACA-Compliant Plans vs. Medicare, Short-Term, and Grandfathered Plans: Who Must Cover What
ACA marketplace plans, Medicaid Alternative Benefit Plans, and CHIP are legally bound to the 10-category list in 2026. Original Medicare and Medicare Advantage are not, because Medicare operates under its own statutory framework: Medicare Part A covers hospital stays, Medicare Part B covers outpatient and medical services, and Medicare Part D covers prescription drugs, with a Medicare Advantage plan required to match or exceed Original Medicare's benefits rather than the ACA's 10-category list. Medigap policies supplement Original Medicare's cost-sharing and are also not subject to the EHB mandate.
Short-term limited-duration insurance is the plan type most likely to surprise a shopper. Because it is not classified as ACA-compliant, an insurer can sell a short-term policy in 2026 that excludes maternity care entirely, caps prescription drug spending at a low dollar amount, or denies a claim tied to a preexisting condition. Grandfathered plans, meaning individual or small-group policies that existed before March 23, 2010 and have not changed significantly since, are also exempt, though very few of these plans remain in force today.
No Annual or Lifetime Dollar Limits on Essential Health Benefits
Before 2010, insurers routinely capped total payouts for a single condition at $1 million to $2 million over a policyholder's lifetime, a limit that cancer patients and premature infants could exhaust within a single hospitalization. Section 2711 of the Public Health Service Act, added by the ACA, now bans any annual or lifetime dollar limit on essential health benefits in every ACA-compliant plan sold in 2026. This protection is why a $500,000 NICU stay for a premature newborn or a multi-year course of chemotherapy cannot exhaust a policy's benefits partway through treatment.
Section 2711's dollar-limit ban only covers the 10 essential health benefit categories, so a plan that is not ACA-compliant, such as a short-term policy, can still impose annual or lifetime caps in 2026. The dollar-limit ban works together with the ACA's preexisting condition protections: because an insurer cannot exclude coverage for a preexisting condition on an ACA-compliant plan, and cannot cap what it pays for the essential benefits tied to that condition, the two rules combine to prevent both denial of coverage and financial exhaustion of coverage.