OE10 Webinar:
September 2022

Part IV: Plan Design

In Part IV of this Beyond the Basics OE10 webinar series presented on September 22, 2022, Sarah Lueck, Vice President for Health Policy, covers the ins and outs of how health insurance plans work as well as an overview of the different types of cost-sharing charges consumers may encounter and how subsidies on the health insurance marketplace can reduce those costs.

Webinar Resources

↓ Presentation Slides (PDF)

↓ Plan Comparison Worksheet

OE10 Webinar

Jump To:

Elements of Qualified Health Plans (QHPs)

  • Overview and basic elements of QHPs
  • Essential health benefits
  • Plan networks
  • Drug formularies

Overview of Cost-Sharing Charges

  • Types of cost-sharing charges
  • Maximum out-of-pocket limit
  • How cost sharing works
  • In-network vs. out-of-network

Actuarial Value

  • Overview of actuarial value and metal tiers
  • Impact of actuarial value on cost-sharing charges

Cost-Sharing Reductions

  • Overview of cost-sharing reductions
  • Examples of how cost-sharing reductions impact cost
  • Cost sharing for American Indians & Alaska Natives (AI/AN)

Plan Design Resources

  • Summary of Benefits & Coverage (SBC)
  • Plan Comparison Worksheet
  • Standardized plans

Skimpy Plans

  • Overview of skimpy plans
  • Risks associated with skimpy plans
  • Coverage restrictions and exclusions in short-term plans

Additional Resources

OE10 Webinar: Part V Plan Selection Strategies

Plan Comparison Worksheet (available in 8 languages)

Key Facts:

HealthCare.gov: Glossary of Health Insurance Terms

OE10 Webinar Series

Papers and Blogs:

Key Flaws of Short-Term Health Plans Pose Risks to Consumers 

More States Protecting Residents Against Skimpy Short-Term Health Plans

Expanding Skimpy Health Plans Is the Wrong Solution for Uninsured Farmers and Farm Workers

“Direct Enrollment” in Marketplace Coverage Lacks Protections for Consumers, Exposes Them to Harm

Kaiser Family Foundation: Understanding Short-Term Limited Duration Health Insurance

The Commonwealth Fund: Expanding Access to Short-Term Health Plans Is Bad for Consumers and the Individual Market

The Commonwealth Fund: State Regulation of Coverage Options Outside of the ACA

Health Reform: Beyond the Basics is a project of the Center on Budget and Policy Priorities designed to provide training and resources that explain health coverage available through Medicaid, CHIP, and the Marketplace. It is aimed at navigators, advocates, state and local officials and others who help consumers get and keep their health coverage.

Stay up to date:

Center on Budget and Policy Priorities

1275 First Street NE, Suite 1200
Washington, DC 20002

Beyondthebasics@cbpp.org

Robert Wood Johnson Foundation

Support for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

© 2013-2021 Center on Budget and Policy Priorities. All Rights Reserved. // Privacy

keyboard_arrow_upBack to top