Does not include a sole proprietor or spouse of and

Silver
Gold
Platinum
60%
70%
40%
30%
Insurer Pay
Patient Pay
80%
90%
20%
10%

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Essential Health Benefits
Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health
treatment
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care
Other Exchange Plans
Catastrophic Coverage
◦ Target Audience
◦ those under age 30
◦ or whose premium > 8% of income
◦ Less coverage, but lower premium
Basic Health Plan
◦ Target Audience
◦ those under 65 with income 133% − 200%
◦ Same coverage, but lower premium instead of subsidizing individual’s premium for regular
coverage
Medicaid and CHIP
◦ Eligibility assessment
State-Run Exchange Basics
May be a governmental agency or State-established
nonprofit entity
May be multiple subsidiaries within one State (with no
overlap in geographic area served), regional (i.e., multi-
state), or single state
◦ Must have at least two multi-state plans in each Exchange
◦ at least one of which must be offered by a nonprofit

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Preventive Care: Contraception
Food and Drug Administration (FDA)-approved contraceptive
methods, sterilization procedures, and patient education and
counseling, as prescribed by a health care provider for women with
reproductive capacity (not including abortifacient drugs)
◦ Does not apply to health plans sponsored by certain exempt
“religious employers.”
Burwell v. Hobby Lobby Stores, Inc.
Issue: Whether the Religious Freedom Restoration Act allows a for-
profit corporation to deny its employees the health coverage of
contraceptives to which the employees are otherwise entitled by
federal law, based on the religious objections of the corporation’s
owners.
Hobby Lobby’s Argument
Hobby Lobby’s owners contend that PPACA's requirement that health insurance
plans cover contraception will force them to either:
◦ violate their religious beliefs or
◦ suffer financial penalties for violating the law
They don't object to covering all contraception
◦ only the emergency contraceptive pills Plan B and Ella, and all types of intrauterine devices
(IUDs)
◦ they (erroneously) believe these are abortifacients
The company admits in its complaint that until it considered filing the suit in
2012, its health insurance plan covered Plan B and Ella.
◦ The company also invests in the makers of both drugs.

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Hobby Lobby Controversy
The company is asking the court to find that it has the same religious-freedom
rights as a church or an individual, a finding no American court has ever made.
◦ Arguably most well-publicized and controversial element of the case
◦