Sabrina Corlette , Kevin Lucia, Max Levin, J.D., M.A.
S. Corlette, K. W. Lucia, M. Levin, Implementing the Affordable Care Act: Choosing an Essential Health Benefits Benchmark Plan, The Commonwealth Fund, March 2013.
To improve the adequacy of private health insurance, the Affordable Care Act requires insurers to cover a minimum set of medical benefits, known as "essential health benefits." In implementing this requirement, states were asked to select a "benchmark plan" to serve as a reference point. This issue brief examines state action to select an essential health benefits benchmark plan and finds that 24 states and the District of Columbia selected a plan. All but five states will have a small-group plan as their benchmark. Each state, whether or not it made a benchmark selection, will have a set of essential health benefits that reflects local, employer-based health insurance coverage currently sold in the state. States adopted a variety of approaches to selecting a benchmark, including intergovernmental collaboration, stakeholder engagement, and research on benchmark options.