Enhancing Essential Health Benefits: How States Are Updating Benchmark Plans to Improve Coverage

Commonwealth Fund November 14, 2024
Stacey Pogue, Vrudhi Raimugia, Justin Giovannelli, Kevin Lucia

TOPLINES

To increase consumers’ access to care, several states have expanded the set of essential health benefits required for coverage by health plans sold in the individual and small-group markets

Recent federal rule changes and grant awards will help states make updates to their essential health benefits package, but further action may be needed to ensure consumers’ needs are being met

Abstract

Issue: To address longstanding gaps in coverage, the Affordable Care Act requires individual and small-group health insurance to cover an essential health benefits (EHB) package. States define the exact scope of these benefits within federal parameters by designating a “benchmark” plan. Federal rules effective in 2020 and 2026 give states additional flexibility to update EHB benchmark plans.

Goal:...

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