Benchmark Plans

What is a Benchmark Plan?

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 2019, limit annual out-of- pocket expenses for covered healthcare delivered in-network to no more than $7,900 for an individual and $15,800 for families.

2019 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 2019 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 - "The State of Arizona EPO Employee Health Plan"
Arkansas - "HMO Partners, Inc. - Small Group Gold 1000-1"
California - "Kaiser Foundation Health Plan Inc. - Small Group HMO 30"
Colorado - "Colorado State LG A230 State Employee Health Plan"
Connecticut - "ConnectiCare Insurance Company, Inc. - Connecticare Flex POS plan"
Delaware - "Highmark BCBSD Inc. - Small Group Shared Cost EPO $2000/100 Plan"
D.C. - "GHMSI - Blue Preferred PPO $1,000 - 100%/80%"
Florida - "Blue Cross and Blue Shield of Florida - BlueOptions 5462"
Georgia - "Humana Employers Health Plan of Georgia, Inc. - Copay Option 22"
Hawaii - "Hawaii Medical Service Association - Preferred Provider Plan 2010"
Idaho - "Blue Cross of Idaho Health Service, Inc. - Preferred Blue PPO Small Group"
Illinois - "Blue Cross Blue Shield of Illinois - Blue PPO Gold 011"
Indiana - "Anthem Ins Companies Inc - Blue 6.0 Blue Access PPO Option 14, Rx G"
Iowa - "Wellmark Inc. - CompleteBlue 2000"
Kansas - "Blue Cross and Blue Shield of Kansas, Inc. - Blue Choice Comprehensive Major Medical"
Kentucky - "UnitedHealthcare of Kentucky, Ltd. - Choice Plus"
Louisiana - "Louisiana Health Service & Indemnity Company - GroupCare Copay 80/60 $1000"
Maine - "Anthem Health Plans of Maine (Anthem BCBS) - Blue Choice, $30.00, $2,500 Ded"
Maryland - "CareFirst BlueChoice, Inc. - BlueChoice HMO HSA-HRA $1,500"
Massachusetts - "Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. - HMO Blue New England $2000 Deductible"
Michigan - "PriorityHealth - PriorityHMO"
Minnesota - "HealthPartners, Inc. - HLPT-129123512"
Mississippi - "Blue Cross Blue Shield of Mississippi - Network Blue"
Missouri - "Healthy Alliance Life Co (Anthem BCBS) - PPO On Exchange"
Montana - "Blue Cross and Blue Shield of Montana - Blue Preferred Gold PPO 007"
Nebraska - "Blue Cross and Blue Shield of Nebraska - Blue Pride Plus Option 102 Gold"
Nevada - "Health Plan of Nevada, Inc. - HPN Solutions HMO Platinum 15/0/90%"
New Hampshire - "Anthem - Matthew Thornton Blue"
New Jersey - "Horizon Healthcare Services, Inc. - Advantage EPO Silver 100/50"
New Mexico - "Presbyterian Health Plan Inc. - Individual Silver C HMO"
New York - "Oxford Health Insurance, Inc. - Oxford EPO"
North Carolina - "Blue Cross and Blue Shield of North Carolina - Blue Options PPO"
North Dakota - "Blue Cross Blue Shield of North Dakota - BlueCare Gold 90 500"
Ohio - "Community Insurance Company (Anthem BCBS) - Blue Access (PPO) - Standard Opt D55"
Oklahoma - "Blue Cross Blue Shield of Oklahoma - Blue Options Gold 002"
Oregon - "PacificSource Health Plans - Preferred Codeduct Value 3000+35/70% 0812 Tiered Value Rx 10/50/75 0812"
Pennsylvania - "Keystone Health Plan East, Inc. - Gold Premier HMO"
Rhode Island - "Blue Cross Blue Shield of Rhode Island - VantageBlue 100/60 1500/3000 RX 3/12/35/60/100 WOPD"
South Carolina - "Blue Cross and Blue Shield of South Carolina - Business Blue Complete"
South Dakota - "Wellmark of South Dakota - Blue Select Primary PCP/NonPCP Copay Plan"
Tennessee - "BlueCross BlueShield of Tennessee - SG Gold 13S"
Texas - "Blue Cross Blue Shield of Texas - Blue Choice PPO RSH3"
Utah - "Public Employees Health Program (PEHP) Utah Basic Plus Plan"
Vermont - "The Vermont Health Plan, LLC - Silver CDHP Plan"
Virginia - "Anthem Health Plans of VA (Anthem BCBS) - Premier DirectAccess PPO"
Washington - "Regence BlueShield - Regence Direct Gold +"
West Virginia - "Highmark Blue Cross Blue Shield West Virginia - Gold Shared Cost PPO $1000"
Wisconsin - "UnitedHealthcare Insurance Company - Choice Plus"
Wyoming - "Blue Cross Blue Shield of Wyoming - BlueSelect Silver for Employer Groups"