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

By Stacey Pogue, Vrudhia Raimugia, Justin Giovannelli, Kevin Lucia

To address longstanding gaps in coverage, the Affordable Care Act requires plans sold in the individual and small-group health insurance markets to cover a comprehensive set of “essential health benefits” (EHB) that reflect typical employer-based coverage. States define the exact scope of these benefits within federal parameters by designating an EHB “benchmark” plan. Federal rules effective in 2020 and 2026 give states additional flexibility to update their EHB benchmark plans, so coverage can keep pace with consumer needs and medical advances.

In a new issue brief for the Commonwealth Fund, CHIR’s Stacey Pogue, Vrudhi Raimugia, Justin Giovannelli, and Kevin Lucia explore how states have used this flexibility to expand EHB to address consumers’ needs or advance state health policy goals. The brief describes how recent rules changes and grant awards will help states and what challenges remain for states and consumers.  You can read the full issue brief here.