Which of the following is one of the categories of essential health benefits (EHBs) that individual and small-group plans must cover?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
The EHB package includes ten categories of care that individual and small-group plans must cover: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services, laboratory services, preventive and wellness services, and pediatric services including limited pediatric dental and vision. Maternity and newborn care is expressly within that list. Cosmetic surgery, custodial care, and adult dental implants are generally excluded by law or plan design and are not EHB categories, which is why they cannot be correct answers here.
Why the other options are wrong
- B) Cosmetic surgery is not an EHB category and is typically excluded from health plans, even though certain reconstructive services that restore function or appearance after injury may be covered.
- C) Custodial, non-skilled long-term care is not an EHB. Medicare also excludes it, and it is addressed by a separate long-term care insurance product rather than medical expense coverage.
- D) Adult dental implants are not required. Only limited pediatric dental services are part of the mandatory EHB package; adult dental coverage remains optional.
Memory hook
Ten EHB baskets: hospital, doctor, ER, baby, mind, drugs, rehab, labs, prevention, kids.