Webinar OE5: Plan Design and Selection
Key Elements of Eligibility and Enrollment
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In this webinar presented on September 26, Sarah Lueck, Senior Policy Analyst, and Halley Cloud, Health Outreach Manager, provide an overview of health plan design—including cost-sharing charges in Marketplace plans, eligibility for cost-sharing reductions, and how cost sharing affect costs for consumers—and detail how to evaluate Marketplace plans based on cost sharing and plan design.
This is Part III in a four-part series on key elements of eligibility and enrollment.
Presentation Slides
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Elements of Plan Design
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Premiums vs. cost-sharing charges
Basic elements of plan design
Cost-sharing charges (video section, slides)
- Types of cost-sharing charges
- Maximum out-of-pocket (OOP) limit
- Metal level plan tiers
- Actuarial value
- Example: How cost sharing works
- Individual vs. family cost-sharing
- In-network vs. out-of-network cost-sharing
Cost-Sharing Reductions
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Definition of cost-sharing reductions (CSR)
- Eligibility for CSR
- Comparing CSR variations
- Zero cost-sharing plans for American Indians and Alaska Natives (AI/AN)
Evaluating Qualified Health Plans
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Summary of benefits and coverage (SBC)
- Visit limits on covered services
- Other covered services
Prescription drug formulary
Provider networks
Comparing Plan Options
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Scenario 1: General plan comparison
Scenario 2: Managing chronic diseases (video section, slides)
Scenario 3: Comparing out-of-pocket costs (video section, slides)
Q&A
Additional Resources
Marketplace Plan Comparison Worksheet | View worksheet
Part I: Premium Tax Credits | View webinar
Part II: Determining Households and Income | View webinar
Part IV: Exemptions | View webinar
Key Facts: Cost-Sharing Charges | View key facts
Key Facts: Cost-Sharing Reductions | View key facts
Beyond the Basics Webinar Series | View all webinars
Key Facts About Health Reform | View all key facts