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What's the Difference Between Benchmark and Standard Health Plans?

Updated: Jun 13

When it comes to navigating the complex world of health insurance, understanding the different types of plans available is crucial. Two common terms you might encounter are "Benchmark" and "Standard" health plans. These terms are often used in the context of health insurance exchanges and government-sponsored healthcare programs. Let’s dive into the key differences between Benchmark and Standard health plans to help you make informed decisions about your healthcare coverage.

Girl shrugging looking confused between benchmark plan and standard plan

Benchmark Health Plans

Benchmark health plans are a key component of health insurance exchanges established under the Affordable Care Act (ACA), also known as Obamacare. These plans serve as a reference point for determining premium subsidies for eligible individuals and families. Here's what you need to know about Benchmark health plans:

  • Reference Point: Benchmark plans are used as a reference point to calculate the amount of financial assistance an individual or family can receive to help lower their monthly premium costs. The subsidies are designed to make health insurance more affordable for those with lower incomes.

  • Essential Health Benefits: Benchmark plans are required to cover a set of essential health benefits mandated by the ACA. These benefits include preventive care, prescription drugs, maternity care, mental health services, and more. This ensures that individuals enrolled in Benchmark plans have access to comprehensive coverage.

  • Varies by State: The specific Benchmark plan can vary from one state to another. Each state has the flexibility to choose its Benchmark plan, typically selecting a popular plan in the state's individual health insurance market.

  • Subsidy Calculation: The subsidy amount an individual or family qualifies for is determined based on the cost of the Benchmark plan and the individual's or family's income. If the cost of the Benchmark plan is higher than a certain percentage of their income, they may be eligible for subsidies to help cover the difference.

Standard Health Plans

Standard health plans are a broader category of health insurance plans that can be offered both inside and outside of health insurance exchanges. While they are not tied to subsidy calculations like Benchmark plans, there are important characteristics that distinguish them:

  • Wide Range of Options: Standard health plans encompass a wide range of insurance options, including various levels of coverage (e.g., bronze, silver, gold, platinum) and different providers. These plans can be purchased directly from insurance companies or through the health insurance marketplace.

  • Customization: Standard health plans allow individuals and families to choose coverage options that suit their needs and budget. This flexibility means that you can select plans with varying levels of deductibles, copayments, and premiums.

  • Not Tied to Subsidies: Unlike Benchmark plans, Standard health plans are not directly tied to subsidy calculations. Eligibility for premium subsidies is determined by factors such as income, household size, and the cost of the Benchmark plan in your area.

  • ACA Compliance: Standard health plans must also comply with the essential health benefits requirement set forth by the ACA. This ensures that they cover a minimum set of essential services.

The primary difference between Benchmark and Standard health plans lies in their roles within the healthcare system. Benchmark plans serve as reference points for subsidy calculations and are used to determine financial assistance for eligible individuals and families. Standard health plans, on the other hand, offer a broader range of coverage options and are available to a wider population, with premium subsidies determined independently of the specific plan chosen.

When choosing a health plan, it's essential to consider your individual healthcare needs, budget, and eligibility for subsidies. As your health insurance agent, Lion’s Pride Insurance can help you understand the differences between Benchmark and Standard health plans and help you make an informed decision to ensure you have the right coverage for your unique circumstances.

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