New Rules Lower OOP Costs on Marketplace Plans

CMS adopted new provisions to lower maximum out-of-pocket costs to consumers by $400 for millions of Americans who will rely on the Federal Health Insurance Marketplaces in plan year 2022. The following 27 states are Federally Facilitated Marketplaces: Alabama, Alaska, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming
 
The annual payment notice makes regulatory changes in the individual and small-group health insurance markets. It also outlines parameters and requirements for issuers to design plans and set rates for the upcoming plan year. The notice also includes regulatory standards to help states, the marketplaces, and insurance issuers in the individual and small-group markets better serve consumer needs.

The second 2022 Notice of Benefit and Payment Parameters final rule includes several provisions to help consumers compare plan options. It also increases opportunities to qualify for special enrollment periods (SEPs). This includes offering consumers a SEP when they have not received timely notice (and were reasonably unaware) of events that would allow them to qualify, and when they no longer receive employer contributions or government subsidies (such as those provided under the American Rescue Plan Act of 2021) for continued employer health coverage under COBRA.
 
Also, those age 30 and over can apply for catastrophic coverage. The calculations will slow the growth rate for cost-sharing, which might otherwise place an undue burden on sicker and lower-income enrollees. When adopted by the IRS, it will also expand eligibility for tax credits to reduce the cost of health insurance premiums for lower-income enrollees.

Several other provisions will make it easier for consumers to comparison shop for plans and improve support for the Federal Health Insurance Marketplaces, health insurance issuers, and other stakeholders.