Webinar OE6: Plan Design

In this Health Reform: Beyond the Basics webinar presented on September 20, 2018, Sarah Lueck, Senior Policy Analyst, provides an overview of health plan design — including cost-sharing charges in marketplace plans, eligibility for cost-sharing reductions, and how plan design affects costs for consumers — and talks about the expansion of skimpy plans outside of the marketplace.

This is Part III is a four-part series on core elements of eligibility and enrollment.

Presentation Slides

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Elements of Plan Design

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Premiums vs. cost-sharing charges

Essential health benefits (EHBs)

Types of cost-sharing charges

  • Maximum out-of-pocket limit
  • Metal levels and actuarial value
  • Example: How cost sharing works
  • Embedded vs. aggregate family cost sharing
  • In-network vs. out-of-network


Cost-Sharing Reductions

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Definition of cost-sharing reductions (CSR)

  • Example CSR plans
  • Termination of CSR payments in 2017
  • Cost sharing for American Indians and Alaska Natives (AI/AN)


Skimpy Plans

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Increase in skimpy plans

  • Skimpy plans vs. ACA-compliant plans

Short-term plans




Additional Resources

Resources | View resources links

Webinar OE6: Plan Selection Strategies

Key Facts:

Reference Guide: Yearly Guidelines and Thresholds

Beyond the Basics Webinar Series | View all webinars

Key Facts About Health Reform | View all key facts

Tools and Resources | View all tools and resources

Frequently Asked Questions | View FAQs