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Health Care Reform:

Health Insurance & Affordable Care Act

Back to ACA Health Insurance Terms List

Benchmark health plan

A benchmark health plan sets the standard for other health plans to meet. It is health plan that other health plans use as a model.

Each state sets a benchmark plan. Any health plan that wants to be sold on the state's health insurance Marketplace must cover the same benefits as the benchmark plan, though it may require higher deductibles and copayments. The model plan is based on a typical health plan offered by a large employer in that state, for example.

Benchmark plans must cover specific essential health benefits as outlined in the Affordable Care Act. These benefits include doctor visits, emergency care, hospitalization, maternity care, mental health care, prescription drug coverage, and others.

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