CMS: States can switch PPACA benchmark plans in 2017

This time around, CMS expects to make a minor change in the selection process: Instead of having to fill out a separate form describing the EHB benchmark plan candidate, a state may be able to e-mail the plan’s form filing directly to CMS, without filling out a separate form.

The drafters of the Patient Protection and Affordable Care Act (PPACA) made the EHB the heart of the commercial health insurance market, and of the PPACA public health insurance exchange system. An EHB package is supposed to include coverage for 10 classes of benefits, such as maternity care, wellness care and hospitalization benefits. 

A state and its health insurers determine whether a given health plans fits in the bronze, silver, gold or platinum “metal level” by calculating the percentage of the actuarial value of the EHB package that the plan covers.

CMS ruled in 2011 that each state should choose an EHB benchmark plan, or let CMS choose the benchmark plan. The benchmark plan can be one of the three largest small-group insurance plans in a state; any of the three largest employee health benefit plan options offered to a state’s state employees; any of the three largest national Federal Employees Health Benefits Program options; or a state’s largest insured commercial health maintenance organization (HMO) plan.