Implementing the Affordable Care Act: Choosing an Essential Health Benefits Benchmark Plan

March 12, 2013 | Volume 15

Authors: Sabrina Corlette, J.D., Kevin W. Lucia, J.D., M.P.H., and Max Levin, J.D., M.A.
Contact: Sabrina Corlette, J.D., Research Professor and Project Director, Center on Health Insurance Reforms, Georgetown University Health Policy Institute sc732@georgetown.edu
Editor: Deborah Lorber

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Overview

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.

Citation

S. Corlette, K. W. Lucia, M. Levin,  Implementing the Affordable Care Act: Choosing an Essential Health Benefits Benchmark Plan, The Commonwealth Fund, March 2013.