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.
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.
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