Benchmark health plan

Each state sets a benchmark plan. Any health plan that wants to be sold on the state's health insurance Marketplace, the individual market, or the small employer market must cover the same benefits as the benchmark plan, though it may have different deductibles and copayments. The benchmark plan is similar to a typical health plan offered by  employers.

Benchmark plans must cover 10 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.

WebMD Medical Reference Reviewed by Sarah Goodell on June 21, 2021
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