24 States and D.C. Select Benchmark Health Insurance Plans That Meet Essential Health Benefit Requirement

Twenty-four states and the District of Columbia have chosen a benchmark health insurance plan that meets the ACA’s essential health benefit requirement, which is scheduled to begin January 2014, according to a new Commonwealth Fund study.

Researchers found that 19 of the states that selected plans chose existing small-group plans, employer-based plans for businesses with fewer than 50 employees. The remaining five states selected HMO or state employee benefit plans.

For those states that did not make a selection, the federal government will designate the largest small-group plan in the state as their benchmark plan.

Designed to ensure that people have comprehensive health coverage, the essential health benefit covers 10 broad service categories, including:

The federal government allows each state to choose a health insurance plan that will be sold by all insurers participating in the new health insurance marketplace.

Researchers from Georgetown University who wrote the report reviewed the steps taken by 50 states and the District of Columbia between January 1, 2012, and October 15, 2012 to select an essential health benefits benchmark plan. They found that states analyzed plan enrollment and costs, and engaged consumer and patient groups, insurers, and specialty physicians in their decision-making process.

The desire to preserve state benefit mandates not included in the federal essential health benefit package was also a factor in choosing benchmark plans.

According to the report, selecting existing small-group market plans, which are similar to what many consumers already have, will mean a smoother transition into the new marketplaces and an easier adjustment to the new rules.

The researchers also conducted in-depth interviews of processes and decisions that took place in selecting a benchmark plan with 10 states — Arkansas, Arizona, California, Connecticut, Mississippi, Montana, North Carolina, North Dakota, Utah, and Washington. These states were chosen because of their diverse approaches to selecting a benchmark plan. These approaches largely reflect the diversity of approaches in all 50 states and the District of Columbia.

Source: The Commonwealth Fund , March 13, 2013

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