Standardized Plans in Individual Market Health Insurance

Key Considerations for Consumer Advocates

The Affordable Care Act (ACA) is an extremely impactful piece of legislation for millions of Americans across the country, requiring that all individual health plans broadly cover similar benefits, adhere to some limits on cost-sharing, and offer plans within specified tiers that cover approximately the same percentage of average medical costs. However, while these types of consumer-centered requirements are largely advantageous for the general public, choosing the right health insurance coverage is complicated.

Standardized plans can help. These plans offer two primary benefits: simplifying plan choice and usage for consumers and improving values for enrollees. By allowing consumers to identify plans that have identical cost-sharing, standardized plans can empower consumers to decide between plans based on their premiums, networks, and overall quality. This new, level playing field can also ultimately promote insurer competition on price, quality, and potentially networks, providing a more simplistic view for consumers which in turn allows them to understand their selected plan and subsequent coverage more fully.

Today, only seven states and the District of Columbia require some or all of the individual marketplace plans offered through the health insurance marketplace be standardized plans.  With a new Congress and a new administration in power, it’s possible federal rules may change soon to ensure standardized plans are offered more widely. For that reason, Consumers for Quality Care partnered with researchers from the McCourt School of Public Policy at Georgetown University to take a closer look at these plans and help consumer advocates prepare for discussions around standardized plan development in states and at the federal level.

Visit our guide, Key Considerations for Consumer Advocates, to learn more about:

  • Potential benefits for consumers offered by standardized plans, like simplifying plan choices and providing higher value coverage for enrollees;
  • Challenges that may prevent the realization of those benefits, including understanding the trade-offs standardization requires around premiums and cost-sharing, copays and coinsurance and other aspects of plan design; and
  • How consumer advocates can be prepared to engage in standardized plan discussions, including identifying goals, being prepared to talk about the trade-offs, and setting expectations for navigating around potential barriers for plan development.

View the Guide: Key Considerations for Consumer Advocates

View the Fact Sheet

View the Press Release

View the Presentation

View the Webinar with CQC and Researchers from Georgetown University’s McCourt School of Public Policy: