consist of the benefits otherwise provided to the indi-
vidual, including cost-sharing relating to such bene-
fits. 
‘‘(5) OVERRIDING
COST-SHARING
AND
COM-
PARABILITY
REQUIREMENTS
FOR
ALTERNATIVE 
BENEFITS.—The provisions of this title relating to 
cost-sharing for benefits (including section 1916) 
shall not apply with respect to benefits to which the 
annual deductible under paragraph (1)(A) applies. 
The provisions of section 1902(a)(10)(B) (relating 
to comparability) shall not apply with respect to the 
provision of alternative benefits (as described in this 
subsection). 
‘‘(6) TREATMENT AS MEDICAL ASSISTANCE.— 
Subject to subparagraphs (D) and (E) of subsection 
(d)(2), payments for alternative benefits under this 
section (including contributions into a health oppor-
tunity account) shall be treated as medical assist-
ance for purposes of section 1903(a). 
‘‘(7) USE OF TIERED DEDUCTIBLE AND COST- 
SHARING.— 
‘‘(A) IN GENERAL.—A State— 
‘‘(i) may vary the amount of the an-
nual deductible applied under paragraph 
(1)(A) based on the income of the family
involved so long as it does not favor fami-
lies with higher income over those with 
lower income; and 
‘‘(ii) may vary the amount of the max-
imum out-of-pocket cost-sharing (as de-
fined in subparagraph (B)) based on the 
income of the family involved so long as it 
does not favor families with higher income 
over those with lower income. 
‘‘(B) MAXIMUM
OUT-OF-POCKET
COST- 
SHARING.—For 
purposes 
of 
subparagraph 
(A)(ii), the term ‘maximum out-of-pocket cost- 
sharing’ means, for an individual or family, the 
amount by which the annual deductible level ap-
plied under paragraph (1)(A) to the individual 
or family exceeds the balance in the health op-
portunity account for the individual or family. 
‘‘(8) CONTRIBUTIONS BY EMPLOYERS.—Noth-
ing in this section shall be construed as preventing 
an employer from providing health benefits coverage 
consisting of the coverage described in paragraph 
(1)(A) to individuals who are provided alternative 
benefits under this section. 
‘‘(d) HEALTH OPPORTUNITY ACCOUNT.—
‘‘(1) IN GENERAL.—For purposes of this sec-
tion, the term ‘health opportunity account’ means an 
account that meets the requirements of this sub-
section. 
‘‘(2) CONTRIBUTIONS.— 
‘‘(A) IN GENERAL.—No contribution may 
be made into a health opportunity account ex-
cept— 
‘‘(i) contributions by the State under 
this title; and 
‘‘(ii) contributions by other persons 
and entities, such as charitable organiza-
tions. 
‘‘(B) STATE
CONTRIBUTION.—A State 
shall specify the contribution amount that shall 
be deposited under subparagraph (A)(i) into a 
health opportunity account. 
‘‘(C) LIMITATION ON ANNUAL STATE CON-
TRIBUTION PROVIDED AND PERMITTING IMPO-
SITION OF MAXIMUM ACCOUNT BALANCE.— 
‘‘(i) IN GENERAL.—A State— 
‘‘(I) may impose limitations on 
the maximum contributions that may 
be 
deposited 
under 
subparagraph
(A)(i) into a health opportunity ac-
count in a year; 
‘‘(II) may limit contributions into 
such an account once the balance in 
the account reaches a level specified 
by the State; and 
‘‘(III) subject to clauses (ii) and 
(iii) and subparagraph (D)(i), may 
not provide contributions described in 
subparagraph (A)(i) to a health op-
portunity account on behalf of an in-
dividual or family to the extent the 
amount of such contributions (includ-
ing both State and Federal shares) 
exceeds, on an annual basis, $2,500 
for each individual (or family mem-
ber) who is an adult and $1,000 for 
each individual (or family member) 
who is a child. 
‘‘(ii) INDEXING
OF
DOLLAR
LIMITA-
TIONS.—For each year after 2006, the dol-
lar amounts specified in clause (i)(III) 
shall be annually increased by the Sec-
retary by an percentage that reflects the 
annual percentage increase in the medical