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Vermont Essential Health Benefits Benchmark

Origin of the EHB Mandate

The Affordable Care Act requires non-grandfathered health plans in the individual and small group markets to cover a set of 10 categories of services - collectively defined as Essential Health Benefits (EHB). Included among these are doctors' services, inpatient and outpatient hospital care, emergency services, rehabilitative and habilitative services and devices, maternity and newborn care and more.

Vermont Essential Health Benefits Benchmark

Each state must develop state-specific EHB benchmark plans indicating the services to be provided covered under each EHB category. In August 2022, the Vermont Essential Health Benefit Benchmark Plan won approval from the Centers for Medicare & Medicaid Services (CMS) to expand coverage to encompass prescription hearing aids. Starting in 2024, individual and small group health plans will cover one set of prescription hearing aids every three years and annual exams. It also increases access to nutritional counseling and rehabilitative services.

Vermont’s new EHB benchmark plan was approved following a public comment period, review by the Green Mountain Care Board, and collaboration with a diverse array of stakeholders. Coverage for hearing aids is also available for individuals enrolled in Medicaid.

Below are links to materials related to Vermont’s EHB Benchmark Plan. Information about Vermont’s 2014-2022 EHB-benchmark plans and associated materials can be found on the CMS website here.