Benefit design influences access, utilization, and outcomes of care, particularly for vulnerable populations. Design features governing cost sharing and covered services have both short and long term cost and value implications for consumers.

While the ACA establishes important new parameters for insurance coverage, states will have some key decisions to make where federal guidance leaves off. States retain control over benefit mandates in the small group and individual markets, as well as in state employee and retiree plans, although they will have to finance any benefits beyond the federal essential benefits package. States will continue to have options for benefits in Medicaid, CHIP, and a state basic health plan, if implemented.