Benchmark Plans

01-04-2016

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Benchmark Plans

The Affordable Care Act (ACA), also referred to as Obamacare, requires state health insurance exchanges to offer four types of healthcare plans: bronze, silver, gold, and platinum. Bronze is the least comprehensive plan in terms of cost-sharing from the insurance company covered while the platinum plan is the most extensive.

The second-lowest priced silver plan available within a state health insurance exchange in a geographical region is called the benchmark plan. Tax credit amounts are derived on the cost of this benchmark plan and are then adjusted according to an enrollee’s annual income. Consumers who are eligible for premium tax credits are not required to purchase the benchmark plan in their region and will not lose out on these credits by choosing a different plan. However, they will face higher premium costs if they choose a more expensive option. All the plans cover the same benefits and, in 2016, limit annual out-of- pocket expenses for covered healthcare delivered in-network to no more than $6,850 for an individual and $13,700 for families.

Benchmark Plans by State

A second type of “benchmark” plan exists for each state. This plan determines the specifics of the Essential Health Benefits required of every Affordable Care Act health plan sold in the state. For example, at the federal level the Affordable Care Act dictates that a health plan must include prescription drug coverage that has at least one on- formulary medication in each therapeutic class or category. However, if a particular state picks a benchmark plan defining benefits that has three drugs in every therapeutic category then health plans sold in that state must cover at least three drugs in every therapeutic category.

The government’s Center for Consumer Information & Insurance Oversight states “In plan years 2014 through 2016, the EHB benchmark plan is a plan that was sold in 2012. For plan year 2017 and beyond, the EHB benchmark plan is a plan that was sold in 2014.”

Below is a list of the Essential Health Benefits benchmark plan for each state. Additional information on the benchmark plans can be found on the government’s CCIIO web site.

  • Alabama - "Blue Cross Blue Shield of Alabama - 320 Plan"
  • Alaska - "Premera Blue Cross Blue Shield of Alaska - Heritage Select Envoy"
  • Arizona - "State of Arizona Self-Insured Plan, administered by United Healthcare - Arizona Benefit Options EPO Plan"
  • Arkansas - "HMO Partners, Inc. - Open Access POS, 13262AR001"
  • California - "Kaiser Foundation Health Plan, Inc. - Kaiser Foundation Health Plan Small Group HMO 30 ID 40513CA035"
  • Colorado - "Kaiser Foundation Health Plan of Colorado - Ded HMO 1200D"
  • Connecticut - "Connecticare, Inc. - Connecticare HMO"
  • Delaware - "Blue Cross Blue Shield of Delaware - Simply Blue EPO 100 500"
  • D.C. - "Group Hospitalization and Medical Services, Inc. - BluePreferred PPO Option 1"
  • Florida - "Blue Cross and Blue Shield of Florida - BlueOptions 5462"
  • Georgia - "BCBS Healthcare Plan of Georgia, Inc. - HMO Urgent Care 60 Copay"
  • Hawaii - "Hawaii Medical Service Association - HMSA Preferred Provider Plan 2010"
  • Idaho - "Blue Cross of Idaho Health Service Inc. - Preferred Blue"
  • Illinois - "Blue Cross Blue Shield of Illinois - BlueCross BlueShield of Illinois BlueAdvantage"
  • Indiana - "Anthem Ins Companies Inc (Anthem BCBS) - Blue 5 Blue Access PPO Medical Option 6 Rx Option G"
  • Iowa - "Wellmark Inc. - Copyament Plus"
  • Kansas - "Blue Cross and Blue Shield of Kansas - Comprehensive Major Medical Blue Choice GF 500 Deductible with Blue Rx card"
  • Kentucky - "Anthem Health Plans of KY (Anthem BCBS) - Anthem PPO"
  • Louisiana - "Blue Cross and Blue Shield of Louisiana - GroupCare PPO"
  • Maine - "Anthem Health Plans of ME (Anthem BCBS) - Blue Choice 20 with Rx 10 30 50 50"
  • Maryland - "CareFirst BlueChoice, Inc. - Blue Choice HMO HSA Open Access"
  • Massachusetts - "Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. - HMO Blue 2000 Deductible"
  • Michigan - "Priority Health - 100 Percent Hospital Services Plan"
  • Minnesota - "HealthPartners, Inc. - 500 25 Open Access"
  • Mississippi - "Blue Cross & Blue Shield of Mississippi - Network Blue"
  • Missouri - "Healthy Alliance Life Co (Anthem BCBS) - Blue 5 Blue"
  • Montana - "Blue Cross and Blue Shield of Montana - Blue Dimensions"
  • Nebraska - "Blue Cross and Blue Shield of Nebraska - Blue Pride"
  • Nevada - "Health Plan of Nevada, Inc. - Health Plan of Nevada Point Of Service Group 1 C XV 500 HCR"
  • New Hampshire - "Matthew Thornton Health Plan (Anthem BCBS) -Matthew Thornton Blue Health Plan"
  • New Jersey - "Horizon HMO - Horizon HMO Access HSA Compatible"
  • New Mexico - "Lovelace Insurance Company - Lovelace Classic PPO"
  • New York - "Horizon HMO - Horizon HMO Access HSA Compatible"
  • North Carolina - "Blue Cross and Blue Shield of NC - Blue Options"
  • North Dakota - "Sanford Health Plan - Sanford Health Plan HMO"
  • Ohio - "Community Insurance Company (Anthem BCBS) - Blue 6 Blue Access PPO Medical Option D4 Rx Option G"
  • Oklahoma - "Blue Cross Blue Shield of Oklahoma - RYB05"
  • Oregon - "PacificSource Health Plans - Preferred CoDeduct Value 3000 35 70"
  • Pennsylvania - "Aetna Health Inc. - PA POS Cost Sharing 34 1500 Ded"
  • Rhode Island - "Blue Cross & Blue Shield of Rhode Island - Vantage Blue BCBSRI"
  • South Carolina - "BlueCross BlueShield of South Carolina - Business Blue Complete"
  • South Dakota - "Wellmark of South Dakota - Blue Select"
  • Tennessee - "BlueCross BlueShield of Tennessee - BCBST PPO"
  • Texas - "Blue Cross Blue Shield of Texas - RS26"
  • Utah - "Public Employee’s Health Program - Utah Basic Plus"
  • Vermont - "The Vermont Health Plan, LLC - BlueCare, The Vermont Health Plan, LLC, CDHP"
  • Virginia - "Anthem Health Plans of VA (Anthem BCBS) - KeyCare 30 with KC30 Rx Plan 10 30 50 OR 20"
  • Washington - "Regence BlueShield - Regence Blue Shield nongrandfathered small group product"
  • West Virginia - "Highmark Blue Cross Blue Shield West Virginia - Super Blue Plus 2000 1000 Ded"
  • Wisconsin - "UnitedHealthcare Insurance Company - Choice Plus Definity HSA Plan A92NS"
  • Wyoming - "Blue Cross Blue Shield of Wyoming - Blue Choice Business 1000 80 20"


Sources:

https://www.cms.gov/CCIIO/Resources/Data-Resources/ehb.html
http://www.cbpp.org/cms/?fa=view&id=3190
http://news.yahoo.com/premiums-unveiled-health-overhaul-plans-041809847--politics.html
http://www.washingtontimes.com/news/2013/sep/25/premiums-unveiled-health-overhaul-plans/#ixzz2g2CcSgrg



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