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States select benchmark plans for essential health benefit required by Affordable Care Act
Date:3/12/2013

New York, NY, March 13, 2013Twenty-four states and the District of Columbia have selected the health insurance plan in their state that will serve as the "essential health benefit" package sold by all insurers participating in the new health insurance marketplace and the individual and small-group markets beginning January 2014, according to a new Commonwealth Fund study. Designed to improve the adequacy of health coverage, the essential health benefit covers 10 broad service categories, including ambulatory patient care, hospitalization, maternity and newborn care, and prescription drugs. The federal government allowed each state to choose a benchmark plan to help meet the Affordable Care Act requirement that the essential health benefit reflect a typical employer health insurance plan.

The report, Implementing the Affordable Care Act: Choosing an Essential Health Benefits Benchmark Plan, by Sabrina Corlette and colleagues at Georgetown University, reviews states' progress in selecting these benchmark plans between January 1, 2012, and October 15, 2012. The authors found that 19 of the states that selected plans chose existing small-group planstypically employer-based plans for businesses with fewer than 50 employees. The remaining five states selected HMO or state employee benefit plans. For states that did not select a benchmark plan, the federal government will designate the largest small-group plan in the state as the benchmark, meaning that the majority of states will have the most widely purchased small-group plan in the state as the basis of their essential health benefit. According to the report, selecting existing small-group market plans, which are similar to what many consumers already have, will likely mean a smoother transition into the new marketplaces and an easier adjustment to the new rules.

"Many consumers who purchased health plans on their own do not have insurance that covers all their health needs," said Commonwealth F
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Contact: Mary Mahon
mm@cmwf.org
212-606-3853
Commonwealth Fund
Source:Eurekalert

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