Which of the following is NOT among the essential health benefit (EHB) categories that Qualified Health Plans must cover?

Why A is correct

The ACA defines ten essential health benefit categories, including 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 pediatric dental and vision). Adult dental and vision are not EHB categories; only the pediatric versions are mandatory.

Why the other options are wrong

• B) Maternity and newborn care is one of the ten enumerated EHB categories.
• C) Mental health and substance use disorder services, including behavioral health treatment, is an EHB category.
• D) Prescription drugs is an explicitly enumerated EHB category alongside emergency services and hospitalization, so it is covered under Qualified Health Plans.

Memory hook

Ten EHB baskets, and adults' teeth and eyes are not in any of them. Kids' care is; adults' is optional.

Why A is correct

The ACA's ten essential health benefit categories are: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. Hospitalization is expressly one of the ten categories, so a non-grandfathered individual or small group plan must cover it as part of its benefit package.

Why the other options are wrong

• B) Cosmetic surgery is not an EHB category; it is generally an excluded, non-essential service under standard medical policies. Cosmetic procedures are not an EHB category and are generally excluded as non-essential.
• C) Long-term custodial care is not an EHB category; custodial care is typically excluded from health policies and is addressed instead by long-term care insurance. Custodial care is outside the ten categories and is handled by long-term care insurance instead.
• D) Vitamins and dietary supplements are not EHB services; they are generally not covered as essential benefits under ACA-compliant plans. Supplements and vitamins are not among the ten categories and are generally not covered.

Memory hook

EHB's big ten: hospitals, doctors, emergencies, babies, minds, drugs, rehab, labs, prevention, kids.

Why A is correct

The ten essential health benefit categories are: 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 chronic disease management; and pediatric services, including oral and vision care. Long-term custodial nursing home care is not among them — it is the province of long-term care insurance. All qualified health plans must cover the EHB categories, so knowing which services are in and out of the basket is a standard definitional question in the PPACA section of the A&H outline.

Why the other options are wrong

• B) Ambulatory patient services are the first EHB category.
• C) Prescription drugs are a mandated EHB category.
• D) Maternity and newborn care is an EHB category.

Memory hook

Ten EHB baskets cover care — and long-term custodial care is not in any.

Why A is correct

The ten EHB categories are: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services including oral and vision care. Custodial long-term care is deliberately absent from the list. It remains the province of long-term care insurance and, after spend-down of assets, Medi-Cal. Recognizing what is inside and outside the EHB list is a direct exam skill.

Why the other options are wrong

• B) Prescription drugs are an express EHB category, so this option is a required benefit rather than an exclusion.
• C) Maternity and newborn care is one of the ten EHB categories, so this option names a benefit the law mandates.
• D) Preventive and wellness services and chronic disease management are expressly included in the EHB list, so this option is also a required category.

Memory hook

EHBs treat diseases and keep you well; they do not bathe, dress, and feed you. Custodial care is out.

Why A is correct

Essential health benefits are the statutorily defined categories of coverage that individual and small-group plans, including qualified health plans, must provide. The categories include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative services, laboratory services, preventive services, and pediatric services including oral and vision care. EHB sets a coverage floor for the commercial market.

Why the other options are wrong

• B) EHB is a broad set of coverage categories, not just emergency and catastrophic care.
• C) EHB is mandatory for individual and small-group plans, not a voluntary employer add-on.
• D) EHB governs commercial individual and small-group plans, not Medicare Part A benefits.

Memory hook

EHB = ten coverage categories every individual and small-group plan must carry.