Essential health benefits are ten categories of care, including hospitalization, prescription drugs, maternity, and mental health, that ACA-compliant individual and small-group plans must cover. The exact services follow each state’s benchmark plan.
Generally no. Under the Newborns’ and Mothers’ Health Protection Act, a plan that covers maternity must pay for at least a 48-hour hospital stay after a vaginal birth (96 hours after a cesarean). You and your doctor can choose to leave earlier, but the insurer can’t require it.
It must be available, though you don’t have to buy it. Children’s dental (age 18 and under) is an ACA essential health benefit, so a dental option must be offered, in a health plan or as a separate dental plan. Adult dental is not an essential health benefit.
The Women’s Health and Cancer Rights Act requires group and individual plans that cover mastectomies to also cover breast reconstruction, prostheses, and treatment of related complications such as lymphedema. Plans must notify members of these rights yearly.
It depends on your state and plan. As of late 2025, 25 states plus Washington, D.C. require some fertility coverage, and 15 of those include in vitro fertilization (IVF). Coverage is not an ACA essential health benefit, so plans not subject to a mandate may exclude it.
Yes. Maternity and newborn care are essential health benefits, so all ACA-compliant individual and small-group plans must cover them. Birth is a qualifying life event that opens a special enrollment period to add the baby.