Standard Benefit Design of Healthcare Exchange
Not only must each plan cover the Essential Health Benefits, they must also follow each state’s standard benefit design. With standardized benefits, consumers can accurately compare health insurance plans because the benefits are the same for all plans. Additionally, standardized benefits assures that the selected health plans define the consumer’s and limit the consumer’s out of pocket costs by type of service.
All states will require essential benefits to be met, but some states may allow providers to define their standardized benefits. California has been the first to release its Standard Benefit Design, the information below is based off their figures. To learn about your standardized benefits in your state call 800-930-7956.
Silver Plan Standard Benefit Design
In the following table, you can see what you would pay based on your income if you bought a Silver Plan. As all plans offer Federal Premium Subsidies, but ONLY the Silver Plan also offers Federal Cost-Sharing Subsidies.
| Category Coverage | 94% Silver | 87% Silver | 73% Silver | 70% Silver |
| Eligibility based on Income Ranges and Associated Tax Credits | Covers 94% of Average Annual Cost | Covers 87% of Average Annual Cost | Covers 73% of Average Annual Cost | Covers 70% of Average Annual Cost |
| Income Ranges | $11,490 -$17,235 | $17,235 -$22,980 | $22,980 -$28,725 | $28,725 -$45,960 |
| Annual Wellness Exam | $0 | $0 | $0 | $0 |
| Primary Care Visit | $3 | $15 | $40 | $45 |
| Specialist Visit | $5 | $20 | $50 | $65 |
| Laboratory Tests | $3 | $15 | $40 | $45 |
| X-Rays and Diagnostics | $5 | $20 | $50 | $65 |
| Imaging | 10% | 15% | 20% | $250 |
| Generic | $3 | $5 | $20 | $25 |
| Out-of-Pocket Max | $2,250/$4,500 (ind/fam) | $2,250/$4,500 (ind/fam) | $5,200/$10,400 (ind/fam) | $6,350/$12,700 (ind/fam) |
For Persons Above the Federal Poverty Line Cut-Off
Many people will not fall into one of the categories above. To see what your costs would be without subsidies click here to compare Bronze, Silver, Gold, Platinum side-by-side.
Further Questions
For any questions regarding standardized benefits of the Healthcare Exchange in your state contact Medicoverage.
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