Health Care

State Based Exchanges

The bill creates state–based exchange for individuals as well as ones for small businesses. The exchanges standardize coverage and make comparison shopping easier through four possible benefit tiers.

In 2014 state–based exchanges will offer health benefit plans and small groups up to 100 employees will be allowed access to exchange. In 2016 states can allow larger business to participate in the exchange.

Bronze Plan Silver Plan Gold Plan Platinum Plan

Must Cover 60 percent of costs with an out–of pocket limit of $5,950/$11,900.

Provides the essential health benefits as defined by the governments.

Must cover 70 percent of the costs of the plans with an out–of pocket limit of $5,950/$11,900.

Provides the essential health benefits as defined by the governments.

Must cover 80 percent of the costs of the plans with an out–of pocket limit of $5,950/$11,900.

Provides the essential health benefits as defined by the governments.

Must cover 90 percent of the costs of the plans with an out–of pocket limit of $5,950/$11,900.

Provides the essential health benefits as defined by the governments.

Essential health benefits

The following services and benefits are required as part of the essential health benefits:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative series
  • laboratory services
  • Prevention and wellness services and chronic disease managements
  • Pediatric services