What are the essential benefits of the Affordable Care Act?

Asked by: Orlando Bahringer  |  Last update: December 10, 2025
Score: 4.8/5 (68 votes)

A set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors' services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover more services.

What are the essential benefits of the ACA?

The Affordable Care Act requires non-grandfathered health insurance coverage in the individual and small group markets to cover essential health benefits (EHB), which include items and services in at least the following ten benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization ...

What are three main points of the Affordable Care Act?

The law has 3 primary goals:
  • Make affordable health insurance available to more people. ...
  • Expand Medicaid to cover all adults with income below 138% of the FPL. ...
  • Support innovative medical care delivery methods designed to lower the costs of health care generally.

How did the Affordable Care Act benefit people?

It did so by expanding Medicaid to people with incomes up to 138% of the federal poverty level (the poverty level in the continental U.S. is $15,060 for a single individual in 2024); creating new health insurance exchange markets through which individuals can purchase coverage and receive financial help to afford ...

Are the 10 essential health benefits cost free?

All Covered California plans have the 10 Essential Health Benefits. The ACA banned annual or lifetime coverage caps on essential health benefits. Preventive care, vaccinations and medical screenings cannot be subject to any cost-sharing when received in network.

Affordable Care Act Explained: 10 Essential Benefits You'll Have | Health Insurance 101 | GoodRx

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Who is eligible for ACA benefits?

All full-time permanent, full-time nonpermanent and ongoing variable-hour, part-time and seasonal employees are eligible for benefits. If an employee is full-time or meets the 30-hour eligibility requirement, he should be offered benefits.

Is there a dollar limit on essential health benefits?

Insurance companies can no longer set a dollar limit on what they spend on essential health benefits for your care during the entire time you're enrolled in that plan.

What are the pros and cons of the Affordable Care Act?

The pros of the ACA include prohibiting insurance companies from denying coverage based on health history and providing subsidies to reduce premiums and out-of-pocket costs. The cons of the ACA include small business challenges and limited provider options in some regions.

Who benefited the most from the ACA?

The biggest winners from the law include people between the ages of 18 and 34; blacks; Hispanics; and people who live in rural areas.

Who is not eligible for Obamacare?

Must live in the United States. Must be a U.S. citizen or national (or be lawfully present). Learn about eligible immigration statuses. Cannot be incarcerated in prison or jail.

How much is Obamacare a month for a single person?

Monthly premiums for Affordable Care Act (ACA) Marketplace plans vary by state and can be reduced by premium tax credits. The average national monthly health insurance cost for one person on an Affordable Care Act (ACA) plan without premium tax credits in 2024 is $477.

Who pays for the Affordable Care Act?

Here, we take a closer look at the coverage options and costs associated with ACA subsidies, and how they fit into overall healthcare spending. The federal government subsidizes health insurance for over 150 million Americans through various programs and tax benefits.

What are 5 mandated benefits under the ACA?

The 10 categories of benefits in an EHB package are: 1) ambulatory patient services, 2) emergency services, 3) hospitalization, 4) maternity and newborn care, 5) mental health and substance use disorder services, 6) prescription drugs, 7) rehabilitative and habilitative services and devices, 8) lab services, 9) ...

What are the main points of the ACA?

INCREASING ACCESS TO AFFORDABLE CARE
  • Providing Access to Insurance for Uninsured Americans with Pre-Existing Conditions. ...
  • Extending Coverage for Young Adults. ...
  • Expanding Coverage for Early Retirees. ...
  • Rebuilding the Primary Care Workforce. ...
  • Holding Insurance Companies Accountable for Unreasonable Rate Hikes.

What are the economic benefits of the Affordable Care Act?

Lower long-term deficits due to the ACA will mean higher national saving, which will increase capital accumulation and reduce foreign borrowing, thereby making workers more productive and increasing national income and living standards over time. 4. Improving health and making workers more productive.

What is the biggest problem with the Affordable Care Act?

Impact on Individual Insurance

It was also known that consumers would face a very different health insurance world under the ACA, with some people seeing their premiums go down and some seeing them go up, and the majority of Americans seeing higher deductibles, higher copays, and a smaller pool of providers.

Who can benefit from the Affordable Care Act?

About the Affordable Care Act

The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level (FPL). Expand the Medicaid program to cover all adults with income below 138% of the FPL.

Why are people against the ACA?

Despite these positive changes, a near majority of Americans still oppose the ACA, even though they approve of most of its features. They oppose the mandate that all Americans must have health insurance (the individual mandate), and they oppose a government role in health care.

Can I refuse health insurance from my employer and get Obamacare?

Obamacare is available to everyone, whether or not their employers offer insurance. From a practical standpoint, though, there are financial consequences to doing this. Often, an employer subsidizes part or all of their employees' coverage.

How much does ACA insurance cost?

Affordable Care Act (ACA) health plans require you to pay a monthly premium, which may be reduced by a premium subsidy — also called a premium tax credit. New legislation means that 4 out of 5 people in the 2025 coverage year will be able to find a plan on the marketplace for $10 or less per month.

What disqualifies you from the premium tax credit?

For tax years other than 2021 and 2022, if your household income on your tax return is more than 400 percent of the federal poverty line for your family size, you are not allowed a premium tax credit and will have to repay all of the advance credit payments made on behalf of you and your tax family members.

What are the 10 essential health benefits under the Affordable Care Act?

10 Essential Health Benefits Insurance Plans Must Cover Under the Affordable Care Act
  • Ambulatory patient services (outpatient services)
  • Emergency services.
  • Hospitalization.
  • Maternity and newborn care.
  • Mental health and substance use disorder services, including behavioral health treatment.
  • Prescription drugs.

Does Obamacare cover surgery?

All plans offered in the Marketplace cover these 10 essential health benefits: Ambulatory patient services (outpatient care you get without being admitted to a hospital) Emergency services. Hospitalization (like surgery and overnight stays)