OE9 Webinar: Part V Plan Design

Health Insurance Plan Design

In this Beyond the Basics webinar presented by the Center on Budget and Policy Priorities on September 30, 2021, Inna Rubin covers the ins and outs of how health insurance plans work. She also provides 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.

View Presentation Slides (PDF)

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Elements of Qualified Health Plans (QHPs)

  • Overview of QHPs
  • Essential health benefits
  • Overview of plan networks
  • Overview of formularies
  • Premiums & cost-sharing charges

Overview of Cost-Sharing Charges

  • Types of cost-sharing charges
  • Maximum out-of-pocket limit
  • Summary of benefits & coverage
  • Overview of family cost-sharing charges
  • Surprise billing protections

Actuarial Value

  • Overview of actuarial value
  • Cost-sharing differences between 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

Skimpy Plans

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

Additional Resources

OE9 Webinar: Part VI Plan Selection Strategies

Plan Comparison Worksheet

Key Facts About Cost-Sharing Reductions

Key Facts About Cost-Sharing Charges